Expandable cage

ABSTRACT

An intervertebral implant that iterates between collapsed and expanded configurations includes first and second plates spaced from one another along a first direction and defining bone-contacting surfaces facing away from each other along the first direction. An expansion assembly is positioned between the plates with respect to the first direction and includes a first support wedge that supports the first plate and defines a first ramp and a second support wedge that supports the second plate and defines second and third ramps. The expansion assembly includes an expansion wedge defining a fourth ramp. The first, second, third, and fourth ramps are each inclined with respect to a second direction that is substantially perpendicular to the first direction. At least one of the first and second support wedges is slidable along the respective supported first or second plate. The implant includes an actuator configured to apply a drive force to the expansion wedge so as to cause 1) the fourth ramp to ride along the third ramp so as to increase a distance between the bone-contacting surfaces along the first direction, and 2) the second ramp to ride along the first ramp, thereby further increasing the distance, thereby iterating the implant from the collapsed to the expanded configuration.

TECHNICAL FIELD

The present invention relates to an expandable intervertebral implant, particularly to an implant having a pair of endplates, at least one of which being independently expandable and rotatable relative to the other, and related methods.

BACKGROUND

Removal of an intervertebral disc is often desired if the disc degenerates. Spinal fusion may be used to treat such a condition and involves replacing a degenerative disc with a device such as a cage or other spacer that restores the height of the disc space and allows bone growth through the device to fuse the adjacent vertebrae. Spinal fusion attempts to restore normal spinal alignment, stabilize the spinal segment for proper fusion, create an optimal fusion environment, and allows for early active mobilization by minimizing damage to spinal vasculature, dura, and neural elements. When spinal fusion meets these objectives, healing quickens and patient function, comfort and mobility improve. Spacer devices that are impacted into the disc space and allow growth of bone from adjacent vertebral bodies through the upper and lower surfaces of the implant are known in the art. Yet there continues to be a need for devices that minimize procedural invasiveness yet stabilize the spinal segment and create an optimum space for spinal fusion.

SUMMARY

According to an embodiment of the present disclosure, an intervertebral implant that is configured to iterate between a collapsed configuration and an expanded configuration includes a first plate and a second plate spaced from one another along a first direction. The first plate defines a first bone-contacting surface and the second plate defines a second bone-contacting surface that faces away from the first bone-contacting surface along the first direction. The implant includes an expansion assembly disposed between the first and second plates with respect to the first direction. The expansion assembly includes a first support wedge that supports the first plate and defines a first ramp and a second support wedge that supports the second plate and defines a second ramp and a third ramp. The expansion assembly includes an expansion wedge that defines a fourth ramp, wherein each of the first, second, third, and fourth ramps is inclined with respect to a second direction that is substantially perpendicular to the first direction. At least one of the first and second support wedges is slidable along the respective supported first or second plate. The implant includes an actuator configured to apply a drive force to the expansion wedge so as to cause 1) the fourth ramp to ride along the third ramp so as to increase a distance between the first and second bone-contacting surfaces along the first direction, and 2) the second ramp to ride along the first ramp, thereby further increasing the distance, thereby iterating the implant from the collapsed configuration to the expanded configuration.

According to another embodiment of the present disclosure, an implant for lateral insertion into an intervertebral space includes an expansion mechanism disposed between a first endplate and a second endplate with respect to a vertical direction. The first endplate defines a first-bone contacting surface and the second endplate defines a second bone-contacting surface that faces away from the first bone-contacting surface along the vertical direction. The expansion mechanism includes an anterior actuation assembly arranged along a first axis and a posterior actuation assembly arranged along a second axis. The first and second axes are each oriented along a longitudinal direction that is substantially perpendicular to the vertical direction. The first and second axes are spaced from one another along a transverse direction that is substantially perpendicular to the vertical and longitudinal directions. A first distance between the first and second bone-contacting surfaces along the vertical direction intersects the first axis, and a second distance between the first and second bone-contacting surfaces along the vertical direction intersects the second axis. The anterior and posterior actuation assemblies each include a first support wedge that supports the first endplate and a second support wedge that supports the second endplate and is slidable with respect to the first support wedge. The actuation assemblies each also include an expansion wedge slidable with respect to the second support wedge, and a drive shaft that is coupled to the expansion wedge and is rotatable about the respective first or second axis so as to cause 1) the expansion wedge to ride along the second support wedge, and 2) the second support wedge to ride along the first support wedge, thereby varying the respective first or second distance. The drive shafts of the anterior and posterior actuation assemblies are rotatable independently of each other so as to provide a difference between the first and second distances.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description of illustrative embodiments of the intervertebral implant of the present application, will be better understood when read in conjunction with the appended drawings. For the purposes of illustrating the expandable intervertebral implant of the present application, there is shown in the drawings illustrative embodiments. It should be understood, however, that the application is not limited to the precise arrangements and instrumentalities shown. In the drawings:

FIG. 1 is an end view of an implant positioned between adjacent vertebral bodies, wherein the implant is in a collapsed configuration, according to a first example embodiment of the present disclosure;

FIG. 2 is a perspective view of the implant of FIG. 1, shown in the collapsed configuration;

FIG. 3 is an end view of the implant of FIG. 1, shown in the collapsed configuration;

FIG. 4 is a longitudinal sectional view of the implant shown of FIG. 1, shown in the collapsed configuration;

FIG. 5 is a partially exploded, perspective view of the implant of FIG. 1, with bone plates of the implant separated in a manner showing an internal expansion mechanism of the implant in a collapsed configuration;

FIG. 6 is an exploded view of the implant of FIG. 1;

FIG. 7 is an enlarged view of an end portion of one of the bone plates shown in FIG. 6;

FIG. 8 is a reverse perspective view of an end portion of the other bone plate shown in FIG. 6;

FIG. 9 is a longitudinal side view of an actuation member of the expansion mechanism shown in FIGS. 5 and 6;

FIG. 10 is a perspective view of a first expansion wedge of the expansion assemblies shown in FIGS. 5 and 6;

FIG. 11 is another perspective view of the first expansion wedge of FIG. 10;

FIG. 12 is a side view of the first expansion wedge of FIG. 10;

FIG. 13 is a perspective view of a variant of the first expansion wedge shown in FIGS. 10 through 12;

FIG. 14 is another perspective view of the variant of the first expansion wedge of FIG. 13;

FIG. 15 is a side view of the variant of the first expansion wedge of FIG. 13;

FIG. 16 is a perspective view of a second expansion wedge of the expansion assemblies shown in FIGS. 5 and 6;

FIG. 17 is another perspective view of the second expansion wedge of FIG. 16;

FIG. 18 is a side view of the second expansion wedge of FIG. 16;

FIG. 19 is a perspective view of a third expansion wedge of the expansion assemblies shown in FIGS. 5 and 6;

FIG. 20 is another perspective view of the third expansion wedge of FIG. 19;

FIG. 21 is a side view of the third expansion wedge of FIG. 19;

FIG. 22 is a perspective view of a fourth expansion wedge of the expansion assemblies shown in FIGS. 5 and 6;

FIG. 23 is another perspective view of the fourth expansion wedge of FIG. 22;

FIG. 24 is a side view of the fourth expansion wedge of FIG. 22;

FIG. 25 is a front end view of the fourth expansion wedge of FIG. 22;

FIG. 26 is a side, partial sectional view of the first and fourth wedges during a first phase of expansion of an expansion assembly shown in FIGS. 5 and 6;

FIG. 27 is a side, partial sectional view of the first and fourth wedges of FIG. 26 between the first phase and a second phase of expansion of the expansion assembly;

FIG. 28 is a side, partial sectional view of the first and fourth wedges during a second phase of expansion of the expansion assembly;

FIG. 29 is a perspective view of an internal end of an expansion assembly of FIGS. 5 and 6, wherein the expansion assembly is shown in an expanded and lordotic configuration;

FIG. 30 is a side view of an actuation assemblies shown in FIGS. 5 and 6, with a proximal expansion assembly shown in a collapsed configuration and a distal expansion assembly shown in a fully expanded configuration for comparison;

FIG. 31 is an enlarged view of the longitudinal sectional view of FIG. 4, showing the implant in the collapsed configuration;

FIG. 32 is a perspective view of the implant of FIG. 1 in a partially expanded configuration;

FIG. 33 is an end view of the implant shown in FIG. 32;

FIG. 34 is a longitudinal sectional view of the implant shown in FIGS. 32 and 33, taken along section line 34-34 of FIG. 33;

FIG. 35 is a longitudinal sectional view of the implant of FIG. 1, shown in a fully expanded configuration;

FIG. 36 is a perspective view of the implant shown in FIG. 35;

FIG. 37 is an end view of the implant shown in FIG. 36;

FIG. 38 is a perspective view of the implant of FIG. 1, shown in a partially expanded, lordotic configuration;

FIG. 39 is a perspective view of the implant of FIG. 38, shown with a bone plate removed for illustrative purposes;

FIG. 40 is an end view of the implant of FIG. 38;

FIG. 41 is an end view of a pair of wedge members of an actuation assembly shown in FIGS. 5 and 6, illustrating rotation of one of the wedge members relative to the other;

FIG. 42 is a perspective view of an implant in a collapsed configuration, according to a second example embodiment of the present disclosure;

FIG. 43 is another perspective view of the implant of FIG. 42, shown with bone plates of the implant separated in a manner showing an internal expansion mechanism of the implant in a collapsed configuration, and also with a top one of the bone plates unfolded in book-like fashion showing internal faces of the bone plates;

FIG. 44 is a perspective view of a pair of wedge members of the expansion mechanism of FIG. 43 positioned along a drive shaft of the expansion mechanism;

FIG. 45 is another perspective view of the wedge members of FIG. 44, shown with one of the wedge members rotated relative to the other wedge member about the drive shaft;

FIG. 46 is an exploded, perspective view of the wedge members of FIG. 44;

FIG. 47 is a perspective view of the implant of FIG. 42 shown in a fully expanded configuration with one of the bone plates removed for illustrative purposes;

FIG. 48 is an end view of the implant of FIG. 42 in a lordotic configuration;

FIG. 49 is a partially exploded perspective view of the implant of FIG. 48; and

FIG. 50 is a perspective view of a driving tool configured to expand the implant shown in FIG. 38.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

The present disclosure can be understood more readily by reference to the following detailed description taken in connection with the accompanying figures and examples, which form a part of this disclosure. It is to be understood that this disclosure is not limited to the specific devices, methods, applications, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the scope of the present disclosure. Also, as used in the specification including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise.

The term “plurality”, as used herein, means more than one. When a range of values is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. All ranges are inclusive and combinable.

Referring to FIG. 1, a superior vertebral body 2 and an adjacent inferior vertebral body 4 define an intervertebral space 5 extending between the vertebral bodies 2, 4. The superior vertebral body 2 defines superior vertebral surface 6, and the adjacent inferior vertebral body 4 defines an inferior vertebral surface 8. The vertebral bodies 2, 4 can be anatomically adjacent, or can be remaining vertebral bodies after an intermediate vertebral body has been removed from a location between the vertebral bodies 2, 4. The intervertebral space 5 in FIG. 1 is illustrated after a discectomy, whereby the disc material has been removed or at least partially removed to prepare the intervertebral space 5 to receive an expandable intervertebral implant 10. The implant 10 is shown in a collapsed configuration, in which configuration the implant 10 can be configured for lateral insertion (i.e., along a medial-lateral trajectory) within the intervertebral space 5.

Once inserted in the intervertebral space 5, the implant 10 can be expanded in a cranial-caudal (i.e., vertical) direction, or otherwise iterated, between the collapsed configuration and a fully expanded configuration to achieve appropriate height restoration. Additionally, one of the sides of the implant 10 can be expanded vertically to a greater extent than the opposite side to achieve lordosis or kyphosis, as disclosed in more detail below.

The intervertebral space 5 can be disposed anywhere along the spine as desired, including at the lumbar, thoracic, and cervical regions of the spine. It is to be appreciated that certain features of the implant 10 can be similar to those set forth in U.S. Patent Publication No. 2014/0243982 A1, published Aug. 28, 2014 in the name of Miller, the entire disclosure of which is incorporated herein by this reference.

Certain terminology is used in the following description for convenience only and is not limiting. The words “right”, “left”, “lower” and “upper” designate directions in the drawings to which reference is made. The words “inner”, “internal”, and “interior” refer to directions towards the geometric center of the implant 10, while the words “outer”, “external”, and “exterior” refer to directions away from the geometric center of the implant. The words, “anterior”, “posterior”, “superior,” “inferior,” “medial,” “lateral,” and related words and/or phrases are used to designate various positions and orientations in the human body to which reference is made. When these words are used in relation to the implant 10 or a component thereof, they are to be understood as referring to the relative positions of the implant 10 as implanted in the body as shown in FIG. 1. The terminology includes the above-listed words, derivatives thereof and words of similar import.

The implant 10 is described herein as extending horizontally along a longitudinal direction “L” and a transverse direction “T”, and vertically along a vertical direction “V”. The longitudinal direction L can be at least substantially perpendicular to each of the transverse and vertical directions T, V. The transverse direction T can be at least substantially perpendicular to each of the longitudinal and vertical directions L, V. The vertical direction V can be at least substantially perpendicular to each of the longitudinal and transverse directions L, T. Unless otherwise specified herein, the terms “longitudinal,” “transverse,” and “vertical” are used to describe the orthogonal directional components of various implant components and implant component axes with reference to the orientation in which the implant 10 is configured to be located in the intervertebral space 5; however, such directional terms can be used consistently with reference to the implant regardless of its actual orientation. Additionally, it should be appreciated that while the longitudinal and transverse directions L, V are illustrated as extending along and defining a horizontal plane (also referred to herein as a “longitudinal-transverse plane”), and that the vertical direction is illustrated as extending along a vertical plane (such as either a “vertical-longitudinal plane” or a “vertical-transverse plane,” as respectively referred to herein), the planes that encompass the various directions may differ during use. For instance, when the implant 10 is inserted into the intervertebral space 5, the vertical direction V extends generally along the superior-inferior (or caudal-cranial) direction, the longitudinal direction L extends generally along the medial-lateral direction, and the transverse direction L extends generally along the anterior-posterior direction. Thus, the horizontal plane lies generally in the anatomical plane defined by the anterior-posterior direction and the medial-lateral direction. Accordingly, the directional terms “vertical”, “longitudinal”, “transverse”, and “horizontal” may be used to describe the implant 10 and its components as illustrated merely for the purposes of clarity and illustration, and such terms. With the foregoing in mind, the terms “expand” and “expansion,” when used in reference to the implant 10, refer to expansion along the vertical direction V.

Referring now to FIG. 2, the implant 10 according to a first embodiment can define a proximal end 12 and a distal end 14 spaced from one another along the longitudinal direction L. In particular, the distal end 14 can be spaced from the proximal end 12 in a distal direction and the proximal end 12 can be spaced from the distal end 14 in a proximal direction opposite the distal direction. Thus, as used herein, the term “longitudinal direction L” is bi-directional and is defined by the mono-directional distal and opposed proximal directions. Additionally, the implant 10 can define an anterior side 16 and a posterior side 18 spaced from one another along the transverse direction T. In particular, the anterior side 16 can be spaced from the posterior side 18 in an anterior direction and the posterior side 18 can be spaced from the anterior side 16 in a posterior direction opposite the anterior direction. Thus, as used herein, the term “transverse direction T” is bi-directional and is defined by the mono-directional anterior and opposed posterior directions.

The implant 10 can include a first or inferior plate 20 and a second or superior plate 22 spaced from each other along the vertical direction V. The inferior and superior plates 20, 22 may be referred to as “endplates.” The inferior plate 20 can define first or inferior plate body 24 and the superior plate 22 can define a second or superior plate body 26. The inferior plate body 24 can define a first or inferior bone-contacting surface 28 on an exterior thereof. The superior plate body 26 can define a second or superior bone-contacting surface 30 on an exterior thereof, as shown in FIG. 3. The inferior and superior bone-contacting surfaces 28, 30 can face away from one another. In particular, the superior bone-contacting surface 30 can face the superior vertebral surface 6 of the superior vertebra 2 and the inferior bone-contacting surface 28 can face the inferior vertebral surface 8 of the inferior vertebral body 4. The inferior and superior bone-contacting surfaces 28, 30 can each be substantially planar; however, in other embodiments, each bone-contacting surface 28, 30 can be at least partially convex, for example, and can at least partially define a texture (not shown), such as spikes, ridges, cones, barbs, indentations, or knurls, which are configured to engage the respective vertebral bodies 2, 4 when the implant 10 is inserted into the intervertebral space 5.

When the implant 10 is in the collapsed configuration, the inferior and superior bone-contacting surfaces 28, 30 can be spaced from one another by a distance D in the range of about 5 mm and about 20 mm along the vertical direction V, by way of non-limiting example, although other sizes are within the scope of the present disclosure. Additionally, when the implant 10 is in the collapsed configuration, the inferior and superior bone-contacting surfaces 28, 30 can be parallel with one another with respect to both the transverse direction T, and thus can have a neutral (i.e., neither lordotic or kyphotic) collapsed profile. As used herein, the terms “lordosis”, “kyphosis”, and their respective derivatives can be used interchangeably, with each term referring to any configuration of the implant 10 wherein the inferior and superior bone-contacting surfaces 28, 30 are angled with respect to each other in the vertical-transverse plane.

It is to be appreciated that the inferior and superior plate bodies 24, 26 can overly one another such that the proximal and distal ends 12, 14 of the implant 10 can be characterized as the proximal and distal ends 12, 14 of each plate 20, 22 or plate body 24, 26. Similarly, the anterior and posterior sides 16, 18 of the implant 10 can also be characterized as the anterior and posterior sides 16, 18 of each plate 20, 22 or plate body 24, 26.

As shown in FIGS. 2 and 3, the proximal end 12 of the implant 10 can include a coupling feature, such as a coupling aperture 32, for receiving an insertion instrument configured to insert the implant 10 into the intervertebral space. The coupling aperture 32 can be collectively defined by the inferior and superior plate bodies 24, 26. The implant 10 can also define one or more vertical apertures 34 (FIG. 2) extending through the inferior and superior plate bodies 24, 26 along the vertical direction V. The vertical apertures 34 can be in communication with one another and with the coupling aperture 32 and can be configured to receive bone growth material following expansion of the implant 10 for fusion with the superior and inferior vertebral bodies 2, 4.

With continued reference to FIG. 2, the implant 10 can generally define an anterior portion 36 and a posterior portion 38 each elongated along the longitudinal direction L and located on opposite sides of the vertical apertures 34 with respect to the transverse direction T. The implant 10 can also generally define a distal portion 40 spaced from the vertical apertures 34 in the distal direction. The distal end 14 of the implant 10 can also be termed the “insertion end” of the implant 10. To facilitate insertion, the superior and inferior plate bodies 12, 18 can each define a tapered surface 42 adjacent the distal end 14, wherein each tapered surface 42 is declined in the distal direction, as shown in FIGS. 2 and 4.

Referring now to FIGS. 5 and 6, each of the inferior and superior plate bodies 24, 26 can define an internal face 44 opposite the respective bone-contacting surface 28, 30 with respect to the vertical direction V. Additionally, the internal faces 44 of the inferior and superior plate bodies 24, 26 can each define one or more internal contact surfaces 46. When the implant 10 is in the collapsed configuration, the internal contact surfaces 46 of the superior plate body 26 can abut the internal contact surfaces 46 of the inferior plate body 24. The internal faces 44 of the inferior and superior plate bodies 24, 26 can be coupled to, and configured to interface with, an expansion mechanism 48 that is configured to move expansion members, such as wedges 51, 52, 53, 54, with respect to one another in a manner expanding the implant 10 along the vertical direction V, as discussed in more detail below.

The internal face 44 of each plate body 24, 26 can also define an anterior channel 56 and a posterior channel 58 each elongated along the longitudinal direction L. The anterior channel 56 and the posterior channel 58 of each plate 20, 22 can extend into the respective plate body 24, 26 from the internal contact surface 46 thereof toward the respective bone-contacting surface 28, 30 along the vertical direction V. The anterior channels 56 of the plates 12, 18 can be located within the anterior portion 36 of the implant 10, and the posterior channels 58 of the plates 12, 18 can be located within the posterior portion 38 of the implant 10. The anterior channels 56 of the plates 12, 18 can overly one another so as to at least partially define a first or anterior compartment 60 of the implant 10, while the posterior channels 58 of the plates 12, 18 can overly one another so as to at least partially define a second or posterior compartment 62 of the implant 10 (FIG. 3). The anterior and posterior compartments 60, 62 can be configured to house components of the expansion mechanism 48. Thus, the compartments 60, 62 can be termed “expansion compartments.”

As shown more clearly in the enlarged view of FIG. 7, the anterior and posterior channels 56, 58 can each extend between opposed anterior and posterior sidewalls 64, 66 spaced apart along the transverse direction T. Each channel 56, 58 can also extend along the vertical direction V from the internal contact surface 46 to a base surface 68 of the channel 56, 58. Thus, the base surface 68 of each channel 56, 58 can be characterized as being vertically recessed within the plate body 24, 26 from the respective internal contact surface 46 toward the respective bone-contacting surface 28, 30. The base surface 68 of each channel can extend along the longitudinal and transverse directions L, T, and can optionally be substantially planar.

Each channel 56, 58 can also include a guide feature, such as a guide slot 70, that is recessed from the base surface 68 toward the bone-contacting surface 28, 30. Each guide slot 70 of the channels 56, 58 can also be referred to as a “plate guide slot” 70. The plate guide slot 70 can have a geometry configured to guide movement of one or more components of the expansion mechanism 48 within the channel 56, 58 along the longitudinal direction L. Optionally, the plate guide slot 70 can also be configured to provide mechanical interference with such components in the vertical direction V toward to the internal contact surface 46 of the associated plate 20, 22. Stated differently, the plate guide slot 70 can optionally have a geometry such that the plate body 24, 26 interlocks with said component of the expansion mechanism 48 in a manner preventing decoupling of the component from the plate guide slot 70 (and, by extension, from the channel 56, 58). Thus, the plate guide slot 70 can also be characterized as a retention feature. For example, the plate guide slot 70 can have a dovetail profile in the vertical-transverse plane, as shown. However, it is to be appreciated that other profiles and geometries of the plate guide slot 70 are within the scope of the present disclosure.

The internal faces 44 of the inferior and superior plate bodies 24, 26 can also define one or more coupling features for coupling the inferior and superior plate bodies 24, 26 together, particularly in the collapsed configuration. The coupling features of the plate bodies 14, 20 can be configured to nest within one another in a manner stabilizing the implant 10 throughout various phases of operation. For example, as shown in FIGS. 5 and 6, at the distal portion 40 of the inferior plate body 24, the internal face 44 can define a first transverse slot 72, a second transverse slot 74 spaced from the first transverse slot 72 in the distal direction, and a transverse wall 76 positioned between the first and second transverse slots 72, 74. The transverse wall 76 can extend along the transverse direction T between an anterior wall end 78 and a posterior wall end 80.

As shown in FIG. 8, at the distal portion 40 of the superior plate body 26, the inner face 44 can define a first transverse protrusion 82 and a second transverse protrusion 84 spaced from the first transverse protrusion 82 in the distal direction. Each of the first and second transverse protrusions 82, 84 can protrude from the superior plate body 26 beyond the internal contact surfaces 46 thereof toward the inferior plate body 24. The first and second transverse protrusions 82, 84 can each extend along the transverse direction T between an anterior end 86 and a posterior end 88, and can extend along the longitudinal direction L between a proximal face 90 and a distal face 92. When the implant 10 is in the collapsed configuration, the first and second transverse protrusions 82, 84 of the superior plate body 26 can nest within the first and second transverse slots 72, 74, respectively, of the inferior plate body 24 (FIG. 4). As the implant 10 expands from the collapsed configuration, the transverse protrusions 82, 84 and transverse slots 72, 74 can effectively stabilize the implant and inhibit relative movement between the inferior and superior plate bodies 24, 26 along the longitudinal direction L.

Referring again to FIGS. 5 and 6, the expansion mechanism 48 can be positioned between the inferior and superior plates 20, 22. In the illustrated embodiment, the expansion mechanism 48 can be configured to convert one or more rotational input forces applied by a physician into one or more corresponding linear expansion forces along the vertical direction V. The expansion mechanism 48 can include one or more actuation assemblies 94, 96 each configured to convert a rotational input force into linear expansion forces along the vertical direction V. As shown, the expansion mechanism 48 can include a first or anterior actuation assembly 94 and a second or posterior actuation assembly 96 spaced from each other along the transverse direction T. The anterior actuation assembly 94 can be configured to convert a first rotational input force R₁ into a plurality of linear expansion forces Z₁, Z₂, Z₃, Z₄, along the vertical direction V so as expand the anterior portion 36 of the implant 10 along the vertical direction V. Similarly, the posterior actuation assembly 96 can be configured convert a second rotational input force R₂ into a plurality of linear expansion forces Z₁, Z₂, Z₃, Z₄, along the vertical direction V so as expand the posterior portion 38 of the implant 10 along the vertical direction V.

The anterior and posterior actuation assemblies 94, 96 can be driven so as to provide uniform or non-uniform expansion or contraction of the implant 10 along the vertical direction, as desired by a physician. For example, either of the actuation assemblies 94, 96 can be driven independently of the other. When driven independently, the anterior and posterior actuation assemblies 94, 96 can expand the anterior and posterior portions 36, 38 of the implant 10 to different expanded heights along the vertical direction V, providing the implant 10 with a lordotic profile in the intervertebral space 5, as discussed in more detail below. Thus, the implant 10 allows vertical expansion within the intervertebral space and adjustment of the lordotic angle of the implant 10 independently of one another.

The anterior and posterior actuation assemblies 94, 96 can be configured substantially similarly; accordingly, the same reference numbers will be used herein with reference to the corresponding components and features of the actuation assemblies 94, 96. Each actuation assembly 94, 96 can include an actuator, such as a drive shaft 98, as also shown in FIG. 9. Each drive shaft 98 can define a central shaft axis X₁ that extends along the longitudinal direction L, and can also define a proximal end 100 and a distal end 102 spaced from one another along the central shaft axis X₁.

With continued reference to FIG. 9, the drive shaft 98 can include one or more threaded portions 104, 106 configured to transmit one or more linear drive forces F₁, F₂ along the longitudinal direction L. For example, the drive shaft 98 can include a first or proximal threaded portion 104 and a second or distal threaded portion 106 spaced from the proximal threaded portion 104 in the distal direction along the central shaft axis X₁. The threading of the proximal and distal threaded portions 104, 106 can have different thread qualities. For example, in the illustrated embodiment, the proximal threaded portion 104 defines a thread pattern that is oriented in a direction opposite that of the distal threaded portion 106. In this manner, upon rotation of the drive shaft 98, the proximal threaded portion 104 can provide a first linear drive force F₁, the distal threaded portion 106 can provide a second linear drive force F₂, and the first and second linear drive forces F₁, F₂ can be opposite one another.

The drive shaft 98 can include an intermediate portion 108 positioned between the proximal and distal threaded portions 104, 106. The threading of the proximal threaded portion 104 can be substantially contiguous with the threading of the distal threaded portion 106 at the intermediate portion 108. Thus, the intermediate portion 108 can define a boundary between the threaded portions 104, 106. In the illustrated embodiment, the intermediate portion 108 can be characterized as an internal end of each of the proximal and distal threaded portions 104, 106, while the proximal end 100 of the drive shaft 98 can define the external end of the proximal threaded portion 104, and the distal end 102 of the drive shaft 98 can define the external end of the distal threaded portion 106. Furthermore, in the illustrated embodiment, the intermediate portions 108 of the anterior and posterior drive shafts 98 can define a center or midpoint of the implant 10 with respect to the longitudinal direction L. Thus, with respect to each threaded portion 104, 106 of the drive shaft 98 (and any component positioned thereon), an external longitudinal direction L_(E) extends from the internal end 108 to the external end 100, 102, and an internal longitudinal direction L_(I) extends from the external end 100, 102 to the internal end 108.

A head 110 can be located at the distal end 102 of the drive shaft 98 and can be contiguous with the distal threaded portion 106. The head 110 can be monolithic with the drive shaft 98 or can be a separate component, such as a nut that is threadedly coupled to the distal threaded portion 106. The head 110 can define a proximal end 112 and a distal end 114 spaced from the proximal end 112 along the longitudinal direction L. A drive coupling, such as a nut socket 116, can be threadedly coupled to the proximal end 100 of the drive shaft 98 and can be contiguous with the proximal threaded portion 104. The nut socket 116 can define a socket aperture 118 extending from a proximal end 120 of the nut socket 116 toward a distal end 122 thereof. The socket aperture 118 can define a hex socket, as depicted, although other socket configurations can be employed for connection to a driving tool operated by a physician.

Referring again to FIGS. 5 and 6, each actuation assembly 94, 96 can include one or more expansion assemblies 124, 126 (also referred to as “wedge assemblies”) that expand along the vertical direction V. For example, a first or proximal wedge assembly 124 can be engaged with the proximal threaded portion 104 of the drive shaft 98 and a second or distal wedge assembly 126 can be engaged with the distal threaded portion 106 of the drive shaft 98. In FIG. 6, the proximal wedge assembly 124 of the posterior actuation assembly 96 is identified in dashed lines, while the distal wedge assembly 126 of the anterior actuation assembly 94 is identified in dashed lines. The proximal and distal wedge assemblies 124, 126 can be characterized as sub-assemblies of the respective anterior and posterior actuation assemblies 94, 96. Additionally, within each actuation assembly 94, 96, the proximal and distal wedge assemblies 124, 126 can optionally be substantial mirror images of one another about a vertical-transverse plane positioned at the intermediate portion 108 of the drive shaft 98. Stated differently, the distal wedge assembly 126 can be configured virtually identical (or at least substantially similar) to the proximal wedge assembly 126, with the primary difference being that the distal wedge assembly 126 is flipped with respect to the longitudinal direction L. Some minor variations in the proximal and distal wedge assemblies 124, 126 will be set forth more fully below.

Each proximal and distal wedge assembly 124, 126 can include a plurality of expansion members, or wedges 51, 52, 53, 54, that are movable relative to each other so as to increase their collective height along the vertical direction V. For example, the expansion members can include a first wedge 51, a second wedge 52, a third wedge 53, and a fourth wedge 54. One or more of the wedges 51, 52, 53, 54 can engage the respective threaded portion 104, 106 of the drive shaft 98.

With reference to FIG. 4, when the implant 10 is in the collapsed configuration, the first wedge 51 can be positioned adjacent the external end of the respective threaded portion 104, 106 of the drive shaft 98; the second wedge 52 can be spaced from the first wedge 51 in the internal longitudinal direction L_(I); the third wedge 53 can be spaced from the second wedge 52 in the internal longitudinal direction L_(I); and the fourth wedge 54 can be spaced from the third wedge 53 in the internal longitudinal direction L_(I). Accordingly, the first wedge 51 can be characterized as an “external-most” wedge, while the fourth wedge 54 can be characterized as an “internal-most” wedge, although other configurations are possible. Additionally, the wedges 51, 52, 53, 54 can define geometries that provide each wedge assembly 124, 126 with telescopic mobility in the longitudinal and vertical directions L, V. Stated differently, the wedges 51, 52, 53, 54 can be shaped such that, as the wedges 51, 52, 53, 54 engage one another, their collective height can increase while their collective length decreases, and vice versa, as set forth in more detail below.

Referring now to FIGS. 10 through 12, the first wedge 51 can have a first wedge body 128 that defines an internal end 130 and an external end 132 spaced from the internal end 130 along the longitudinal direction L. The first wedge body 128 can also define anterior and posterior side surfaces 134, 136 spaced from each other along the transverse direction T. The external end 132 of the first wedge body 128 can define an external face 138 extending between an upward apex 140 and a bottom or base surface 142 of the body 128 along the vertical direction V. The external face 138 can be substantially planar, although other geometries are within the scope of the present disclosure. The external face 138 can be configured to abut another component of the implant 10 in a manner limiting or preventing motion of the first wedge body 128 in the external longitudinal direction L_(E) during operation of the implant 10 within a patient. For example, in the proximal wedge assembly 124, the external face 138 of the first wedge 51 can be configured to abut the distal end 122 of the nut socket 116, by way of non-limiting example.

The upward apex 140 can be located at the external end 132 of the first wedge body 128. The base surface 142 of the first wedge body 128 can be configured to engage the base surface 68 of the respective anterior or posterior channel 56, 58 of the inferior plate body 24. At least a portion of the base surface 142 of the first wedge body 128 can be substantially planar and can be configured to translate at least partially across the base surface 68 of the respective channel 56, 58, for example, at least during assembly of the implant 10. In other embodiments, once in place within the respective channel 56, 58, the first wedge 51 can be fixed to the inferior plate body 24, such as by welding, brazing, adhesives, or mechanical fasteners. In further embodiments, the first wedge 51 can be monolithic with the inferior plate body 24. As the first wedge 51 can be characterized as “supporting” the inferior plate body 24, the first wedge 51 can be referred to herein as a “support member” or a “support wedge.”

In the illustrated embodiments, the first wedge 51 can also include a first or inferior guide element, such as a guide protrusion 144, that is configured to translate within the plate guide slot 70 of the associated channel 56, 58 during assembly of the implant 10, for example. The guide protrusion 144 can extend from the base surface 142 of the first guide body 128. A bottom surface 146 of the guide protrusion 144 can define a bottom-most portion of the first wedge 51 and of the respective wedge assembly 124, 126. The guide protrusion 144 can have a geometry that is configured to guide movement of the first wedge body 128 within the respective channel 56, 58 along the longitudinal direction L. Additionally, the guide protrusion 144 of the first wedge body 128 and the respective guide slot 70 of the inferior plate body 24 can be cooperatively shaped so that the first wedge body 128 interlocks with the inferior plate body 24 in a manner preventing the first wedge body 128 and the inferior plate body 24 from detaching along the vertical direction V. For example, the guide protrusion 144 and the plate guide slot 70 can have corresponding dovetail profiles in the vertical-transverse plane, as shown, although other geometries are within the scope of the present disclosure. In this manner, the first wedge 51 can be longitudinally movable but substantially vertically immovable within the respective channel 56, 58 of the inferior plate body 24. Thus, the guide protrusion 144 can also be characterized as a retention feature of the first wedge 51. Additionally, the profiles of the guide protrusion 144 and of the plate guide slot 70 can allow the first wedge 51 and the inferior plate body 24 to be rotationally interlocked with one another so that, for example, the first wedge 51 and the inferior plate body 24 can maintain the same angular position about the central shaft axis X₁ during expansion and optionally during lordosis. In other embodiments, the rotational interlocking of the first wedge 51 and the inferior plate body 24 can allow rotation of the first wedge 51 about the central shaft axis X₁ to cause a substantially similar degree of rotation of the inferior plate body 24 about the central shaft axis X₁, and vice versa.

The first wedge body 128 can also include an engagement element configured to engage a portion of one or more other wedges of the respective wedge assembly 124, 126, such as the second wedge 52 and the fourth wedge 54, for example. The engagement element can include a first inclined surface, or ramp 148, extending between the internal end 130 and the upward apex 140 of the first wedge body 128. When positioned within the respective actuation assembly, 94, 96, the first wedge 51 can be oriented so that the first ramp 148 is inclined in the external longitudinal direction L_(E). In the illustrated embodiment, the first ramp 148 can be oriented at a first incline angle α₁ in a range of about 10 degrees and about 60 degrees with respect to the longitudinal direction L (FIG. 12). In other embodiments, the first incline angle α₁ can be in the range of about 20 degrees and about 40 degrees with respect to the longitudinal direction L. In further embodiments, the first incline angle α₁ can be in the range of about 25 degrees and about 35 degrees with respect to the longitudinal direction L. In additional embodiments, the first incline angle α₁ can be less than 10 degrees or greater than 60 degrees with respect to the longitudinal direction L.

The first wedge body 128 can also define a second or superior guide feature, such as a guide slot 150, configured to guide relative motion between the first wedge 51 and another wedge of the associated wedge assembly 124, 126, such as the fourth wedge 54, for example. The guide slot 150 can be recessed into the first wedge body 128 from the first ramp 148. The guide slot 150 can extend from a guide slot opening 152 at the internal end 130 of the first wedge body 128 to the external face 138 of the first guide body 128 with respect to the longitudinal direction L. The guide slot 150 can extend parallel with the first ramp 148 and can have a geometry configured to guide movement therein of an associated guide element of the fourth wedge 54. Optionally, the guide slot 150 can also be configured to interlock with the associated guide element in a manner preventing the fourth wedge 54 from detaching from the first wedge 51, at least in a direction orthogonal to the first ramp 148. As shown, the guide slot 150 can have a dovetail profile in the vertical-transverse plane, although other geometries are within the scope of the present disclosure. The guide slot 150 can traverse an entire length of the first ramp 148, as shown, or can optionally traverse less than the entire length. Additionally, the guide slot 150 can separate the first ramp 148 into anterior and posterior portions 154, 156, which can be characterized as “rails.”

The first wedge body 128 can define a channel 158 extending through the body 128 along the longitudinal direction L. The channel 158 can be U-shaped, and portions of the first wedge body 128 located on opposite transverse sides of the channel 158 can be characterized as anterior and posterior arms 160, 162 of the first wedge body 128 (FIG. 10). The channel 158 can be sized, shaped, and/or otherwise configured to provide space for the respective threaded portion 104, 106 of the drive shaft 98 to extend at least partially through the body 128 (i.e., between the arms 160, 162) without mechanically interfering with the body 128. Accordingly, the first wedge body 128 can have a U-shaped profile in a vertical-transverse plane. The channel 158 can also intersect the guide slot 150 in a manner effectively dividing a portion of the guide slot 150 into anterior and posterior slots 164, 166 defined in the anterior and posterior arms 160, 162, respectively.

Referring now to FIGS. 13 through 15, a variation of the first wedge 51′ is shown. In particular, the variant 51′ can be employed in the posterior actuation assembly 96. The variant 51′ can be substantially similar to the first wedge 51 shown in FIGS. 10 through 12; thus, like reference numbers can be used, with the corresponding features of the variant first wedge 51′ denoted with a “prime” notation. The primary difference in the variant first wedge 51′ can be that the external face 138′ of the first wedge body 128′ is a first external face 138′ that is defined by a transversely external one of the anterior and posterior arms 160′, 162′. Additionally, the opposite (i.e., transversely internal) one of the arms 160′, 162′ can define a second external face 139′ that is recessed from the first external face 138′ in the internal longitudinal direction L_(I).

The first external face 138′ of the first wedge 51′ can abut the proximal side 112 of the head 110, and the second external face 139′ can abut the proximal face 90 of the first transverse protrusion 82 of the superior plate body 26 (FIG. 30). Thus, the proximal face 90 of the first transverse protrusion 82 can be termed an abutment surface of the superior plate body 26. Such a configuration can add stability to the implant 10 at least during expansion, contraction, and/or lordotic angulation of the implant 10. In other embodiments, however, the first wedge 51 of the distal wedge assembly 126 can be virtually identical to the first wedge 51 of the proximal wedge assembly 124. As with the first wedge 51, the variant 51′ can be characterized as a “support member” or “support wedge” and can optionally be rigidly fixed to the inferior plate body 24 by welding, brazing, adhesives, or mechanical fasteners. It is to be appreciated that the variant first wedge 51′ of the anterior actuation assembly 94 can be a substantial mirror image of its counterpart in the posterior actuation assembly 96 about a vertical-longitudinal plane positioned between the actuation assemblies 94, 96.

Referring now to FIGS. 16 through 18, the second wedge 52 can have a second wedge body 168 that defines an internal end 170 and an external end 172 spaced from the external end 172 along the longitudinal direction L. The second wedge body 168 can also define anterior and posterior side surfaces 174, 176 spaced from each other along the transverse direction T. The second wedge body 168 can also define an external face 178 at the external end 172. The external face 178 of the second wedge body 168 can extend along the vertical and transverse directions V, T and can be substantially planar, although other geometries are within the scope of the present disclosure. The second wedge body 168 can also define an upper base surface 180 and an opposed downward apex 182 spaced from the upper base surface 180 along the vertical direction V. The upper base surface 180 can extend along the longitudinal direction L between the internal and external ends 170, 172 of the body 168. The downward apex 182 can be located between the external and internal ends 170, 172 of the second wedge body 168 with respect to the longitudinal direction L.

The upper base surface 180 can be configured to engage the base surface 68 of the respective anterior or posterior channel 56, 58 of the superior plate body 26. Accordingly, the second wedge 52 can be characterized as “supporting” the superior plate body 26 and can be referred to herein as a “support member” or “support wedge.” At least a portion of the upper base surface 180 can be substantially planar and can be configured to translate at least partially across the base surface 68 of the respective channel 56, 58 during expansion of the implant 10. Thus, the second wedge 52 can also be referred to as a “slider.”

The second wedge body 168 can define a third or superior guide element, such as a guide protrusion 184, extending from the upper base surface 180 along the vertical direction V. A top surface 186 of the guide protrusion 184 can define a top-most portion of the second wedge 52. The top surface 186 can also define a top-most portion of the respective wedge assembly 124, 126. The guide protrusion 184 can be configured to translate within the guide slot 70 of the associated channel 56, 58 of the superior plate body 26. The guide protrusion 184 of the second wedge body 168 can have a design and function generally similar to those of the guide protrusion 144 of the first wedge body 128 set forth above. By way of non-limiting example, the guide protrusion 184 of the second wedge body 168 and the guide slot 70 of the associated channel 56, 58 of the superior plate body 26 can have corresponding dovetail profiles that interlock the second wedge 52 to the superior plate body 26. In this manner, guide protrusion 184 (which can also be characterized as a “retention” feature) can be longitudinally movable but substantially vertically immovable within the respective channel 56, 58 of the superior plate body 26. Additionally, the profiles of the guide protrusion 184 and of the plate guide slot 70 can allow the second wedge 52 and the superior plate body 26 to be rotationally interlocked with one another so that, for example, rotation of the second wedge 52 about the central shaft axis X₁ of the drive shaft 98 causes a substantially similar degree of rotation of the superior plate body 26 about the central shaft axis X₁, and vice versa.

The second wedge 52 can include one or more engagement elements configured to engage portions of one or more of the other wedges of the associated wedge assembly 124, 126. By way of non-limiting example, the second wedge body 168 can define a second inclined surface, or ramp 188, extending from the external face 178 to the downward apex 182, and a third inclined surface, or ramp 190, extending from the downward apex 182 to the internal end 170 of the second wedge body 168. The internal end 170 of the second wedge body 168 can define a shared edge between the upper base surface 180 and the third ramp 190. The second wedge 52 can be oriented in each actuation assembly 94, 96 so that the second ramp 188 is inclined in the external longitudinal direction L_(E) and the third ramp 190 is declined in the external longitudinal direction L_(E) (and thus inclined in the internal longitudinal direction L_(I)). The second ramp 188 can be configured to engage the first ramp 148 of the first wedge body 128 during expansion of the implant 10. The third ramp 190 can be configured to engage a portion of another wedge of the respective wedge assembly 124, 126, such as the third wedge 53, for example.

The second ramp 188 can optionally be substantially parallel with the first ramp 148 of the first wedge body 128. The second ramp 188 can be oriented at a second incline angle α₂ in a range of about 10 degrees and about 60 degrees with respect to the longitudinal direction L (FIG. 18). In other embodiments, the second incline angle α₂ can be in the range of about 20 degrees and about 40 degrees with respect to the longitudinal direction L. In further embodiments, the second incline angle α₂ can be in the range of about 25 degrees and about 35 degrees with respect to the longitudinal direction L. In additional embodiments, the second incline angle α₂ can be less than 10 degrees or greater than 60 degrees with respect to the longitudinal direction L.

The third ramp 190 can be oriented at a third incline angle α₃ in the range of about 10 degrees and about 60 degrees with respect to the longitudinal direction L. In other embodiments, the third incline angle α₃ can be in the range of about 20 degrees and about 40 degrees with respect to the longitudinal direction L. In further embodiments, the third incline angle α₃ can be in the range of about 25 degrees and about 35 degrees with respect to the longitudinal direction L. In additional embodiments, the third incline angle α₃ can be less than 10 degrees or greater than 60 degrees with respect to the longitudinal direction L.

The second wedge 52 can include a fourth guide feature, such as a guide slot 192, configured to guide relative motion between the second wedge 52 and another wedge of the associated wedge assembly 124, 126, such as the third wedge 53, for example. The guide slot 192 can be recessed into the second wedge body 168 from the third ramp 190 and can separate the third ramp 190 into anterior and posterior portions 194, 196, which can be characterized as “rails.” The guide slot 192 can extend parallel with the third ramp 190 and can have a geometry configured to guide movement of, and optionally interlock with, an associated guide element of the third wedge 53. As shown, the guide slot 192 can have a dovetail profile, and can be configured similarly to the guide slot 150 of the first wedge body 128, as set forth above, although other geometries are within the scope of the present disclosure. The guide slot 192 can extend from a guide slot opening 198 at the upper base surface 180 to a stop feature 200 configured to prevent the guide element of the third wedge 53 from moving beyond the stop feature 200 along the external longitudinal direction L_(E). The stop feature 200 can be spaced from the downward apex 182 in the internal longitudinal direction L_(I). Thus, the guide slot 192 can extend less than an entire length of the third ramp 190.

The second wedge body 168 can define a channel 202 extending therethrough along the longitudinal direction L. The channel 202 of the second wedge body 168 can be configured similarly to the channel 158 of the first wedge body 128 set forth above. Thus, the second wedge body 168 can have a U-shaped profile in a vertical-transverse plane and can include anterior and posterior arms 204, 206 on opposite transverse sides of the channel 202. Additionally, the channel 202 can separate the second ramp 188 into anterior and posterior portions 208, 210, which can be characterized as “rails.” The channel 202 can also intersect the guide slot 192 in a manner effectively converting a portion of the guide slot 192 into anterior and posterior slots 212, 214 defined in the anterior and posterior arms 204, 206, respectively.

Referring now to FIGS. 19 through 21, the third wedge 53 can have a third wedge body 216 that defines an internal end 218 and an external end 220 spaced from the internal end 218 along the longitudinal direction L. The third wedge body 216 can also define anterior and posterior side surfaces 222, 224 spaced from each other along the transverse direction T. The third wedge body 216 can also define an internal face 226 at the internal end 218 thereof and an external face 228 at the external end 220. The internal and external faces 226, 228 of the third wedge body 216 can each extend along the vertical and transverse directions V, T and can each be substantially planar, although other geometries are within the scope of the present disclosure. The third wedge body 216 can define a central bore 230 extending along a central bore axis X₂. The central bore 230 can be a through bore, and the central bore axis X₂ can extend along the longitudinal direction L. The central bore 230 can define threading 232 that is configured to engage at least one of the proximal and distal threaded portions 104, 106 of the drive shaft 98 so that rotation of the drive shaft 98 threadedly translates the third wedge 53 along the longitudinal direction L. Accordingly, the central bore axis X₂ can be coextensive with the central shaft axis X₁. The third wedge body 216 can also be configured to rotate about the central bore axis X₂, as set forth in more detail below.

The third wedge 53 can include one or more engagement elements configured to engage portions of one or more of the other wedges of the associated wedge assembly 124, 126, such as the second and fourth wedges 52, 54. For example, the internal face 226 of the third wedge 53 can be configured to engage (such as by abutting) a portion of the fourth wedge 54. Additionally, the third wedge body 216 can define a fourth inclined surface, or ramp 234, located at an upper side of the body 216. The fourth ramp 234 can extend between the internal and external faces 226, 228 along the longitudinal direction L. The fourth ramp 234 can be declined in the external longitudinal direction L_(E) (and thus inclined in the internal longitudinal direction L_(I)).

The fourth ramp 234 can be configured to engage the third ramp 188 of the second wedge body 168, including during expansion of the implant 10. The fourth ramp 234 can optionally be substantially parallel with the third ramp 190 of the second wedge body 168. The fourth ramp 234 can be oriented at a fourth incline angle α₄ in a range of about 10 degrees and about 60 degrees with respect to the longitudinal direction L (FIG. 21). In other embodiments, the fourth incline angle α₄ can be in the range of about 20 degrees and about 40 degrees with respect to the longitudinal direction L. In further embodiments, the fourth incline angle α₄ can be in the range of about 25 degrees and about 35 degrees with respect to the longitudinal direction L. In additional embodiments, the fourth incline angle α₄ can be less than 10 degrees or greater than 60 degrees with respect to the longitudinal direction L.

The third wedge 53 can include a fifth guide element, such as a guide protrusion 236, configured to guide motion between the third wedge 53 and the second wedge 52. For example, the guide protrusion 236 of the third wedge 53 can extend vertically from the fourth ramp 234 and can be configured to translate within the guide slot 192 of the second wedge 52. The guide protrusion 236 can be cooperatively shaped with the guide slot 192 in a manner preventing the guide protrusion 236 from exiting the guide slot 192, at least in a direction orthogonal to the third ramp 190. For example, the guide protrusion 236 and the guide slot 192 can have corresponding dovetail profiles in a vertical-transverse plane, as shown. In such an embodiment, the guide protrusion 236 can only enter and exit the guide slot 192 through the guide slot opening 198. Additionally, the profiles of the guide slot 192 and the guide protrusion 236 can allow the second and third wedges 52, 53 to be rotationally interlocked with one another so that, for example, rotation of the third wedge 53 about the central bore axis X₂ causes a substantially similar degree of rotation of the second wedge 52 about the central bore axis X₂.

The third wedge 53 can have a geometry configured to avoid contact with the first wedge 51 during relative movement between the first and third wedges 51, 53. For example, the third wedge body 216 can have a rounded underside 238 configured so as not to contact or otherwise directly engage or interfere with the first ramp 148 or the anterior and posterior arms 160, 162 of the first wedge body 128 during translational and rotational movement of the third wedge body 216 over the first wedge body 128. Additionally, the underside 238 can define a fifth inclined surface, or ramp 240, that is oriented at a fifth incline angle α₅ that is substantially parallel with the first incline angle α₁ of the first ramp 148. The fifth ramp 240 can be configured so as not to contact the first ramp 148. For example, the fifth ramp 240 can include a pair of planar portions 242 positioned on opposite transverse sides of a rounded portion 244. The rounded portion 244 can be configured to extend within the guide slot 150 of the first wedge body 128 without contacting the first ramp 148 or any other portion of the first wedge body 128 during translational and rotational movement of the third wedge body 216 over the first wedge body 128. Additionally, the planar portions 242 of the fifth ramp 240 can be remote from the first ramp 148 or any other portion of the first wedge body 128 during movement of the third wedge body 216 over the first wedge body 128.

Referring now to FIGS. 22 through 25, the fourth wedge 54 can have a fourth wedge body 246 that defines an internal end 248 and an external end 250 spaced from the internal end 248 along the longitudinal direction L. The fourth wedge body 246 can also define anterior and posterior side surfaces 252, 254 spaced from each other along the transverse direction T. The fourth wedge body 246 can also define an internal face 256 at the internal end 248 thereof and an external face 258 at the external end 250. The internal and external faces 256, 258 of the fourth wedge body 246 can each extend along the vertical and transverse directions V, T and can each be substantially planar, although other geometries are within the scope of the present disclosure. The fourth wedge body 246 can include a top surface 260 and a bottom surface 262 opposite the top surface 260 with respect to the vertical direction V. The bottom surface 262 can also be referred to as a “base” surface of the fourth wedge 54, and can extend along the longitudinal and transverse directions L, T. The bottom surface 262 can optionally be planar. The fourth wedge body 246 can be rounded or chamfered between the top surface 260 and the side surfaces 252, 254 so as to avoid contacting or otherwise directly engaging or interfering with the third ramp 190 or any other portion of the second wedge body 168 during translational and rotational movement of the fourth wedge body 246 under the second wedge body 168, for example.

The fourth wedge body 246 can define a central bore 264 extending along a central bore axis X₃. The central bore 264 can be a through bore and can extend along the longitudinal direction L. The central bore axis X₃ of the fourth wedge body 246 can be coextensive with the central shaft axis X₁ of the drive shaft 98 and with the central bore axis X₂ of the third wedge body 216. The central bore 264 of the fourth wedge body 246 can define threading 266 that is configured to engage the same one of the proximal and distal threaded portions 104, 106 as the threading 232 of the third wedge body 216. In the illustrated embodiments, rotation of the drive shaft 98 can threadedly translate the third and fourth wedges 53, 54 together along the longitudinal direction L at the same rate. However, in other embodiments, the third and fourth wedges 53, 54 of each wedge assembly 124, 126 can move at different rates and/or in opposite directions along the drive shaft 98.

The fourth wedge 54 can include one or more engagement elements configured to engage portions of at least one of the other wedges of the associated wedge assembly 124, 126, such as the third wedge 53. For example, the external face 258 of the fourth wedge body 246 can be characterized as an engagement element because it can be configured to abut the internal face 226 of the third wedge body 216. The external face 258 of the fourth wedge body 54 can optionally be configured to abut the internal face 226 of the third wedge body 216 in a manner ensuring that the third and fourth wedge bodies 216, 158 translate along the respective threaded portion 104, 106 of the drive shaft 98 at the same rate. In this manner, the fourth wedge 54 can be characterized as a “pusher” or a “pusher member” that effectively pushes the third wedge 53 in the external longitudinal direction L_(E). Additionally, it is to be appreciated that the third and fourth wedges 53, 54 can collectively be referred to as an “expansion wedge”, with the third wedge 53 being referred to as a “first member” or “first portion” of the expansion wedge, and the fourth wedge 54 being referred to as a “second member” or “second portion” of the expansion wedge. Additionally, each of the third and fourth wedges 53, 54 can be referred to individually as an “expansion wedge.”

The fourth wedge body 246 can also define a sixth inclined surface, or ramp 268, adjacent the bottom surface 262 of the body 246. The sixth ramp 268 can extend between the bottom surface 262 and the external face 256 of the fourth wedge body 246 with respect to the longitudinal direction L. The sixth ramp 268 can be inclined in the external longitudinal direction L_(E) (and thus declined in the internal longitudinal direction L_(I)). The sixth ramp 268 can be configured to engage the first ramp 148 of the first wedge body 128 during expansion of the implant 10. The sixth ramp 268 can optionally be substantially parallel with the first ramp 148. The sixth ramp 268 can be oriented at a sixth incline angle α₆ in a range of about 10 degrees and about 60 degrees with respect to the longitudinal direction L (FIG. 24). In other embodiments, the sixth incline angle α₆ can be in the range of about 20 degrees and about 40 degrees with respect to the longitudinal direction L. In further embodiments, the sixth incline angle α₆ can be in the range of about 25 degrees and about 35 degrees with respect to the longitudinal direction L. In additional embodiments, the sixth incline angle α₆ can be less than 10 degrees or greater than 60 degrees with respect to the longitudinal direction L.

The fourth wedge 54 can include a sixth guide element, such as a guide protrusion 270, configured to guide motion between the fourth wedge 54 and each of the inferior plate 12 and the first wedge 51. The guide protrusion 270 can extend from each of the bottom surface 262 and the sixth ramp 268. The guide protrusion 270 can be configured such that, in one phase of expansion of the implant 10, the protrusion 270 can translate within the guide slot 70 of the respective channel 68 of the inferior plate body 24 and, during another phase of expansion, the protrusion 270 can translate within the guide slot 150 of the first wedge 51.

The guide protrusion 270 of the fourth wedge body 246 can include one or more portions configured to selectively engage guide features of the inferior plate body 24 and guide features of the first wedge 51. For example, in the non-limiting example shown in FIGS. 22 through 24, the guide protrusion 270 can include a first portion 271, a second portion 272, a third portion 273, and a fourth portion 274. The first portion 271 can extend from the sixth ramp 268. The fourth portion 274 can extend from the bottom surface 262. The second portion 272 can be located underneath the first portion 271. The third portion 273 can be generally underneath the fourth portion 274. The first and fourth portions 271, 274 can each have a rectangular profile in the vertical-transverse plane. The second and third portions 272, 273 can each have a dovetail profile in the vertical-transverse plane. On each of the anterior and posterior sides 252, 254 of the fourth wedge body 246, an edge 276 between the first and second portions 271, 272 can be parallel with the bottom surface 262. Also on each side 252, 254, an edge 278 between the third and fourth portions 273, 274 can be parallel with the sixth ramp 268. The second portion 272 can taper transversely inward toward the first portion 271 from an edge 280 between the second and third portions 272, 273. The third portion 273 can taper transversely inward toward the fourth portion 274 from the edge 280 between the second and third portions 272, 273.

As shown in FIG. 26, during a first phase of expansion of the implant 10, the second, third and fourth portions 272, 273, 274 of the guide protrusion 270 of the fourth wedge 54 can be positioned within the respective plate guide slot 70 while the first portion 271 is positioned external of the plate guide slot 70. As shown in FIG. 27, at the conclusion of the first phase, which can also be considered the commencement of a second phase of expansion, the protrusion 270 can be simultaneously positioned in both the plate guide slot 70 and the guide slot 150 of the first wedge 51. The geometry of the protrusion 270 allows it to transition from the plate guide slot 70 to the first wedge guide slot 150, and to remain within the first wedge guide slot 150 during the second phase of expansion, as shown in FIG. 28. During the second phase, the first, second, and third portions 271, 272, 273 of the guide protrusion 270 can be positioned within the guide slot 150 of the first wedge 51 while the fourth portion 274 can be external of the guide slot 150.

It is to be appreciated that the dovetail profile of the guide protrusion 270, particularly at the edge 280 between the second and third portions 272, 273, can substantially match the dovetail profiles of the guide slots 70 of each channel 62, 64 as well as the guide slot 102 of the first wedge 51. The second portion 272 of the guide protrusion 270 can be configured to allow the guide protrusion 270 to transfer from the guide slot 70 of the inferior plate body 24 to the guide slot 150 of the first wedge 51 between the first and second phases. The third portion 273 of the guide protrusion 270 can be configured to allow the guide protrusion 270 to transfer from the guide slot 150 of the first wedge 51 to the guide slot 70 of the inferior plate body 24 during an optional reverse expansion process (i.e., during a collapsing or “contracting” process) of the implant 10, as set forth in more detail below.

The third portion 273 of the guide protrusion 270, particularly at the edge 280 between the second and third portions 272, 273, can be cooperatively shaped with the guide slot 150 of the first wedge 51 in a manner preventing the guide protrusion 270 from exiting the guide slot 150, at least in a direction orthogonal to the first ramp 148 and optionally in any direction except a direction parallel with the first ramp 148. In the illustrated embodiment, the guide protrusion 270 can enter and exit the guide slot 150 only at the internal end 130 (through the guide slot opening 198) or optionally at the external end 132 of the first wedge body 128.

Additionally, the second portion 272 of the guide protrusion 270, particularly at the edge 280 between the second and third portions 272, 273, can be cooperatively shaped with the guide slot 70 of the respective channel 62, 64 of the inferior plate body 24 in a manner preventing the guide protrusion 270 from exiting the guide slot 70, at least in a direction orthogonal to the channel base surface 68 and optionally in any direction except the longitudinal direction L or a direction parallel with the first ramp 148. Additionally, the profiles of the guide protrusion 270 and of the plate guide slot 70 can allow the inferior plate body 24 to be rotationally interlocked with the fourth wedge 54 when the guide protrusion 270 is within the plate guide slot 70 (FIG. 26) so that, for example, the fourth wedge 54 and the inferior plate body 24 can maintain the same angular position about the central shaft axis X₁. Because the first wedge 51 can be rotationally interlocked with the inferior plate body 24 (FIG. 40), and the fourth wedge 54 can be rotationally interlocked with either the inferior plate body 24 or with the first wedge 51 (FIGS. 26 through 28), the inferior plate body 24 can thus be rotationally interlocked with both of the first and fourth wedges 51, 54 during all phases of expansion.

It is to be appreciated that, in the illustrated embodiment, the second, third and fourth wedges 52, 53, 54 of the proximal wedge assembly 124 can be substantially similar, or even virtually identical, to their respective counterparts in the distal wedge assembly 126. However, in other embodiments, one or more of the second, third and fourth wedges 52, 53, 54 of the proximal wedge assembly 124 can be configured differently than their respective counterparts in the distal wedge assembly 126.

Referring now to FIG. 29, a distal wedge assembly 126 is illustrated during the second phase of expansion. The profiles of the guide slot 192 of the second wedge 52 and the guide protrusion 236 of the third wedge can allow the second wedge 52 to be rotationally interlocked with the third wedge 53 as the third wedge 53 rotates relative to the fourth wedge 54 about the axis X₁ of the drive shaft 98, as set forth above. Additionally, as also set forth above, the profiles of the guide slot 150 of the first wedge 51 and the guide protrusion 270 of the fourth wedge 54 can allow the first and fourth wedges 51, 54 to be rotationally interlocked with one another when the guide protrusion 270 is within the guide slot 150 so that, for example, the first and fourth wedges 51, 54 maintain the same angular position about the central shaft axis X₁ or, in other embodiments, so that the first and fourth wedges 51, 54 rotate by the same degree about the central shaft axis X₁ during operation of the implant 10.

Referring now to FIG. 30, the wedges 51, 52, 53, 54 of each wedge assembly 124, 126 can have telescopic mobility in the longitudinal and vertical directions L, V. It is to be appreciated that, when the implant 10 is in the collapsed configuration, each of the anterior and posterior actuation assemblies 94, 96, and each of the proximal and distal wedge assemblies 124, 126 can also be considered as being in its respective collapsed configuration. For purposes of comparison, FIG. 30 depicts the proximal wedge assembly 124 in the collapsed configuration while the distal wedge assembly 124 is depicted in the fully expanded configuration. Each wedge assembly 124, 126 can define a length, measured from the external face 138 of the first wedge 51 to the internal face 256 of the fourth wedge 54 along the longitudinal direction L, and a height, measured from the bottom surface 146 of the guide protrusion 144 of the first wedge 51 to the top surface 186 of the guide protrusion 184 of the second wedge 122 along the vertical direction V. In the collapsed configuration, each wedge assembly 124, 126 can define a collapsed length L_(I) and a collapsed height H₁. In the fully expanded configuration, each wedge assembly 124, 126 can define an expanded length L₂ that is less than the collapsed length L_(I), and an expanded height H₂ that is greater than the collapsed height H₁. Stated differently, each wedge assembly 124, 126 can decrease in length as it increases in height. The ratio of the expanded height H₂ to the collapsed height H₁ can be in the range of about 1.5:1 to 3.5:1, by way of non-limiting example. Accordingly, the vertical distance D between the bone-contacting surfaces 28, 30 (FIG. 31) can also increase by a similar margin during expansion of the implant 10. For example, the vertical distance D can increase by a factor in the range of about 1.05 and about 3.0 from the collapsed configuration to the fully expanded configuration, by way of non-limiting example.

Operation of the implant 10, including expansion and lordosis, will now be discussed with reference to FIGS. 31 through 41, beginning with the implant in the collapsed configuration, as shown in FIG. 31.

Referring now to FIG. 31, while the posterior actuation assembly 96 is depicted, it is to be appreciated that the following description can also apply to the corresponding components of the anterior actuation assembly 94. When the implant 10 is in the collapsed configuration, the internal contact surfaces 46 of the inferior and superior plate bodies 24, 26 can abut one another. Additionally, when collapsed, each actuation assembly 94, 96 can be disposed substantially entirely within the associated compartment 60, 62 (FIG. 2) defined by the overlying channels 56, 58 of the plates 12, 18. The proximal end 120 of the nut socket 116 can be generally aligned with the proximal end 12 of the implant 10 along the transverse direction T. The drive shaft 98 can extend along the longitudinal direction L through the channels 56, 58. One or both of the distal end 114 of the head 110 and the distal end 102 of the drive shaft 98 can abut or be adjacent to the proximal face 90 of the second transverse protrusion 84 of the superior plate body 26. The proximal end 112 of the head 110 can abut or be adjacent to the distal face 92 of the first transverse protrusion 82 of the superior plate body 26. In this manner, the head 110 can be aligned with the transverse wall 76 of the inferior plate body 24 along the transverse direction T.

With reference to the proximal wedge assembly 124 in the collapsed configuration, the external face 138 of the first wedge 51 can abut or be adjacent to the distal end 122 of the nut socket 116. The bottom base surface 142 of the first wedge 51 can abut the base surface 68 of the posterior channel 58 of the inferior plate body 24 and the guide protrusion 144 of the first wedge 51 can be received within the guide slot 70 of the posterior channel 58 of the inferior plate body 24. The proximal threaded portion 104 of the drive shaft 98 can extend through the U-shaped channel 158 of the first wedge 51.

The second wedge 52 can be positioned such that the second ramp 188 abuts the first ramp 148 at a location adjacent the internal end 130 of the first wedge 51. The upper base surface 180 of the second wedge 52 can abut the base surface 68 of the posterior channel 58 of the superior plate body 26 and the guide protrusion 184 of the second wedge 52 can be received within the guide slot 70 of the posterior channel 58 of the superior plate body 26. The proximal threaded portion 104 of the drive shaft 98 can extend through the U-shaped channel 202 of the second wedge 52.

The third wedge 53 can be positioned such that the fourth ramp 234 thereof abuts the third ramp 190 of the second wedge 52 at a location adjacent the internal end 170 thereof. The guide protrusion 236 of the third wedge 53 can be received within the guide slot 192 of the second wedge 52. The drive shaft 98 can extend through the central bore 230 of the third wedge 53, with the threading 232 thereof engaged with the proximal threaded portion 104 of the drive shaft 98.

The fourth wedge 54 can be positioned such that the external face 258 thereof abuts or is adjacent to the internal face 226 of the third wedge 53. The internal face 256 of the fourth wedge 54 can be positioned at or adjacent the intermediate portion 108 of the drive shaft 98 (i.e., the internal end of the proximal threaded portion 104). The bottom surface 262 of the fourth wedge 54 can abut the base surface 68 of the posterior channel 58 of the inferior plate body 24 and the guide protrusion 270 of the fourth wedge 54 can be received within the guide slot 70 of the posterior channel 58 of the inferior plate body 24. The drive shaft 98 can extend through the central bore 264 of the fourth wedge 53, with the threading 266 thereof engaged with the proximal threaded portion 104 of the drive shaft 98.

It is to be appreciated that, as set forth above, the distal wedge assembly 126 can effectively be a substantial mirror image of the proximal wedge assembly 124 about a vertical-transverse plane positioned at the intermediate portion 108 of the drive shaft 98. Thus, the relative positions of the wedges 51′, 52, 53, 54 of the distal wedge assembly 126 and the distal threaded portion 106 of the drive shaft 98 can be substantially similar to that of the proximal wedge assembly 124 and the proximal threaded portion 104 of the drive shaft. With regards to the variant of the first wedge 51′, the first external face 138′ thereof can abut or be adjacent the proximal end 112 of the head 110 (FIG. 5) while the second external face 139′ of the first wedge 51′ can abut or be adjacent to the proximal face 90 of the first transverse protrusion 82 of the superior plate body 26 (FIG. 4).

Expansion of the implant 10 between the collapsed configuration and a first partially expanded configuration, as shown in FIGS. 32 through 34, will now be discussed, according to an example mode of expansion. It is to be appreciated that, while FIGS. 32 through 34 depict the anterior and posterior actuation assemblies 94, 96 actuated concurrently so as to expand the implant 10 uniformly, each of the anterior and posterior actuation assemblies 94, 96 can be operated independently to provide non-uniform expansion or contraction of the implant 10 (i.e., lordosis).

During a first phase of expansion, the drive shaft 98 can be rotated about its central shaft axis X₁ in a first rotational direction (such as clockwise, for example) so that the proximal threaded portion 104 provides a first or proximal drive force F₁ in the external longitudinal direction L_(E) thereof (i.e., the proximal direction) and the distal threaded portion 106 provides a second or distal drive force F₂ in the external longitudinal direction L_(E) thereof (i.e., the distal direction). The threading 232, 178 of the central bores 146, 176 of the third and fourth wedges 53, 54, respectively, can engage the associated threaded portion 104, 106 of the drive shaft 98 in a manner transmitting the respective drive force F₁, F₂ to the third and fourth wedges 53, 54 causing the third and fourth wedges 53, 54 to translate in the external longitudinal direction L_(E).

Referring to FIG. 34, as the third and fourth wedges 53, 54 translate, each of the following can occur: the bottom surface 262 of the fourth wedge 54 rides along the base surface 68 of the respective anterior channel 56, 58 of the inferior plate 20; the guide protrusion 270 of the fourth wedge 54 rides within the guide slot 70 of the respective channel 56, 58; the fourth ramp 234 of the third wedge 53 rides along the third ramp 190 of the second wedge 52; and the guide protrusion 236 of the third wedge 53 rides within the guide slot 192 of the second wedge 52. The vertical distance D between the inferior and superior bone-contacting surfaces 28, 30 can increase by a factor in the range of about 0.2 and about 1.0 as a result of the fourth ramp 234 riding along the third ramp 190. As the fourth ramp 234 rides along the third ramp 190, the first drive force F₁ can be conveyed at least to the second wedge 52 causing the second ramp 188 (not visible in FIG. 34) to ride along the first ramp 148 of the first wedge 51, further increasing the distance D between the bone-contacting surfaces 28, 30 along the vertical direction V by a factor in the range of about 0.2 to 1.0 (with respect to the collapsed distance D).

As the fourth ramp 234 rides along the third ramp 190 and as the second ramp 188 rides along the first ramp 148, the sixth ramp 268 of the fourth wedge 54 can approach the first ramp 148 of the first wedge 51. In the present example, the first phase of expansion can be complete when the sixth ramp 268 abuts the first ramp 148, at which point the protrusion 270 of the fourth wedge 54 can enter the opening 152 of the guide slot 150 of the first wedge 51 (FIG. 28). As set forth above, the geometry of the guide protrusion 270 of the fourth wedge 54 can allow the protrusion 270 to be simultaneously positioned within the plate guide slot 70 and the guide slot 150 of the first wedge 51 at the conclusion of the first phase of expansion (and at the commencement of the second phase of expansion).

At the conclusion of the first phase and commencement of the second phase of expansion, the external end 172 of the second wedge 52, as well as the entire second ramp 188, can be positioned intermediate the internal and external ends 130, 132 of the first wedge 51 with respect to the longitudinal direction L. Moreover, the entire fourth ramp 234 can be positioned intermediate the downward apex 182 and the internal end 170 of the second wedge 52, while the protrusion 236 of the third wedge 53 can be positioned intermediate the stop feature 200 and the opening 198 of the guide slot 192 of the second wedge 52, each with respect to the longitudinal direction L. It is to be appreciated that, while views of the internal end 90 of the first wedge 51 and the downward apex 182 and stop feature 200 of the second wedge 52 are each obstructed in FIG. 34, such features are visible in FIG. 31.

Expansion of the implant 10 between the first partially expanded configuration, as shown in FIGS. 32 through 34, and a fully expanded configuration, as shown in FIGS. 35 through 37, will now be discussed, according to the example mode of expansion.

Referring now to FIGS. 35 through 37, the implant 10 is shown uniformly expanded at the conclusion of the second phase of expansion, which can be commensurate with the fully expanded configuration. As above, it is to be appreciated that the anterior and posterior actuation assemblies 94, 96 can each be operated independently to provide non-uniform expansion or contraction of the implant 10 (i.e., lordosis) between the first partially expanded configuration and the fully expanded configuration.

Referring to FIGS. 35 through 37, during the second phase of expansion, the drive shaft 98 can be further rotated about its central shaft axis X₁ in the first rotational direction. The threading 232, 178 of the third and fourth wedges 53, 54, respectively, can continue to engage the associated threaded portion 104, 106 of the drive shaft 98 in a manner translating the third and fourth wedges 53, 54 further in the external longitudinal direction L_(E). The second phase of expansion can be characterized as when the sixth ramp 268 rides along the first ramp 148, which yet further increases the distance D between the inferior and superior bone-contacting surfaces 28, 30.

As the fourth wedge 54 translates at the commencement of the second phase of expansion, the protrusion 270 can transition from the guide slot 70 of the channel 56, 58 of the inferior plate body 24 to the guide slot 150 of the first wedge 51. In particular, the geometry of the first, second, third and fourth portions 271, 272, 273, 274 of the protrusion 270 can engage the guide slot 150 of the first wedge 51 so that the protrusion 270 is caused to exit the plate guide slot 70 and to be received entirely within the guide slot 150 of the first wedge 51. Additionally, the fifth ramp 240 of the third wedge 53 can extend within the guide slot 150 of the first wedge 51 without contacting the first wedge body 128.

During at least a portion of the second phase of expansion, the sixth ramp 268 can ride along the first ramp 148 while the fourth ramp 234 rides along the third ramp 190, resulting in relative motion between the second wedge 52 and each of the third and fourth wedges 53, 54 along the longitudinal and vertical direction L, V. Such relative motion between the second wedge 52 and the third and fourth wedges 53, 54 during the second phase can cause the second ramp 188 to separate from, or otherwise become remote from, the first ramp 148 with respect to the vertical direction V. Additionally, such relative motion between the second wedge 52 and the third and fourth wedges 53, 54 can be initiated by a reactionary force imparted to at least one of the second, third, and fourth wedges 52, 53, 54. For example, the reactionary force can occur when a component of the implant 10, such as a stop feature in the channel 56, 58, the guide slot 70, or other portion of the plate body 24, 26, impedes motion of the second wedge 52 in the external longitudinal direction L_(E). In another non-limiting example, the second and sixth ramps 124, 180 can ride along the first ramp 148 at or near the same rate until, in the proximal wedge assembly 124, the external face 178 of the second wedge 52 abuts the distal end 122 of the nut socket 116 while, in the distal wedge assembly 126, the external face 178 of second wedge 52 abuts the proximal face 90 of the first transverse protrusion 82. In each of the proximal and distal wedge assemblies 124, 126, the foregoing abutments can impede further movement of the second wedge 52 along the external longitudinal direction L_(E) while the fourth ramp 234 continues to ride along the third ramp 190 and the sixth ramp 268 continues to ride along the first ramp 148, thus driving the second wedge 52 upward with respect to the first wedge 51.

In another non-liming example, the reactionary force can occur at the commencement of the second phase of expansion, causing the fourth ramp 234 to ride along the third ramp 190 as soon as the sixth ramp 268 rides along the first ramp 148. In such an example, in each of the proximal and distal wedge assemblies 124, 126, the fourth ramp 234 can ride along the third ramp 190 until the guide protrusion 236 of the third wedge 53 abuts the stop feature 200 of the guide slot 192 of the second wedge 52, after which the sixth ramp 268 can continue to ride along the first ramp 148 without any relative motion between the second wedge 52 and the third and fourth wedges 53, 54 along the longitudinal and vertical directions L, V. Thus, in each of the two preceding non-limiting examples, the second phase of expansion can include at least one portion or sub-phase that involves relative motion between the second wedge 52 and each of the third and fourth wedges 53, 54 with respect to the longitudinal and vertical directions L, V, and at least one other portion or sub-phase during which the second, third, and fourth wedges 52, 53, 54 are driven together along the longitudinal and vertical directions L, V without any relative motion therebetween.

In yet another non-limiting example, relative motion can occur between the second wedge 52 and each of the third and fourth wedges 53, 54 along the longitudinal and vertical directions L, V during substantially the entire second phase of expansion. In this example, in each of the proximal and distal wedge assemblies 124, 126, the reactionary force can occur at the commencement of the second phase of expansion, causing the fourth ramp 234 to ride along third ramp 190 and the guide protrusion 236 of the third wedge 53 to concurrently ride within the guide slot 192 as soon as the sixth ramp 268 rides along the first ramp 148. Furthermore, in this example, the guide protrusion 236 of the third wedge 53 can abut the stop feature 200 of the second wedge 52 substantially at the same time as the external face 178 of the second wedge 52 abuts the distal end 122 of the nut socket 116.

At the conclusion of the second phase of expansion, in the proximal wedge assembly 124, the external end 172 of the second wedge 52 can be substantially aligned with the external end 132 of the first wedge 51 along the vertical direction V, and, in the distal wedge assembly, the external end 172 of the second wedge 52 can be substantially aligned with the second external face 139′ of the first wedge 51′. Additionally, in each wedge assembly 124, 126, the third and fourth wedges 53, 54 can each be entirely intermediate the internal and external ends 130, 132 of the first wedge 51 as well as the external and internal ends 170, 172 of the second wedge 52. Similarly, at the conclusion of the second phase of expansion, the downward apex 182 of the second wedge 52 can be spaced upward of the upward apex 140 of the first wedge 51.

Throughout expansion of the implant 10, the respective first wedges 51, 51′ of the proximal and distal wedge assemblies 124, 126 can remain adjacent the external ends of the proximal and distal threaded portions 104, 106 of the drive shaft 98. Additionally, the second, third and fourth wedges 52, 53, 54 of each wedge assembly 124, 126 can move in the external longitudinal direction L_(E) during expansion. Thus, the points of contact between the wedge assemblies 124, 126 and the superior and inferior plates 12, 28 are either initially located adjacent the proximal and distal ends 12, 14 of the implant 10 (as in the case of the first wedges 51, 51′ coupled to the inferior plate 20) or move toward the proximal and distal ends 12, 14 of the implant 10 during expansion (as in the case of the second wedges 52 coupled to the superior plate 22). Such an arrangement provides enhanced support and stability to the implant 10 during expansion, particularly with respect to reactive forces, such as inner body forces, imparted to the implant 10 along the vertical direction V within the intervertebral space 5. However, it is to be appreciated that, in other embodiments (not shown), the respective first wedges 51, 51′ of the proximal and distal wedge assemblies 124, 126 can be located adjacent the internal ends of the threaded portions 104, 106 of the drive shaft 98, and the second, third and fourth wedges 52, 53, 54 of each wedge assembly 124, 126 can move in the internal longitudinal direction L_(I) during expansion.

Operation of the implant 10 to achieve lordosis will now be discussed.

Referring now to FIGS. 38 through 40, the anterior and posterior actuation assemblies 94, 96 can be driven independently in a manner providing the implant 10 with a lordotic profile, as set forth above. Stated differently, the anterior and posterior actuation assemblies 94, 96 can be operated in a manner causing at least one of the inferior and superior plates 20, 22 to tilt relative to the other plate 20, 22 with respect to the transverse direction T. In some embodiments, at least one of the plates 20, 22 can tilt relative to the other plate 20, 22 about at least one of the first and second central shaft axes X₁. This can be accomplished by placing the wedge assemblies 124, 126 of one of the anterior and posterior actuation assemblies 94, 96 at a degree of expansion that is different than that of the wedge assemblies 124, 126 of the other actuation assembly 94, 96. In the example lordotic configuration of FIGS. 38 through 40, in the posterior actuation assembly 96, the proximal and distal wedge assemblies 124, 126 thereof can be at about the collapsed configuration (FIG. 39) while, in the anterior actuation assembly 94, the wedge assemblies 124, 126 thereof can be expanded to near the first partially expanded configuration, thus causing the superior plate 22 to tilt relative to the inferior plate 20 with respect to the transverse direction T at a lordotic angle β (FIG. 40).

When at least one of the plates 20, 22 is tilted lordotically with respect to the other, a first distance D₁ between the inferior and superior bone-contacting surfaces 28, 30, measured along the vertical direction L and intersecting the central shaft axis X₁ of the anterior actuation assembly 94, can be shorter or longer than a second distance D₂ between the inferior and superior bone-contacting surfaces 28, 30, measured along the vertical direction L and intersecting the central shaft axis X₁ of the posterior actuation assembly 96. Additionally, when at least one of the plates 20, 22 is tilted lordotically with respect to the other, a vertical distance D₃ between the inferior and superior plates 20, 22 at the anterior side 16 of the implant 10 can be shorter or longer than a vertical distance D₄ between the plates 20, 22 at the posterior side 18 of the implant 10. As shown in FIG. 40, one of D₃ and D₄ can be as small as zero, at which point the internal contact surfaces 46 at the respective side 16, 18 of the implant 10 can define a fulcrum. In some embodiments, the internal faces 44 of the inferior and superior plate bodies 24, 26 can be curved, canted or can otherwise define a gap therebetween at one or both of the anterior and posterior sides 16, 18 so that at least one of the plates 20, 22 can be tilted lordotically while one of the anterior and posterior actuation assemblies 94, 96 is in the collapsed configuration (i.e., lordosis can be induced from the collapsed configuration).

It is to be appreciated that the lordotic profile illustrated in FIGS. 38 through 40 represents merely one of numerous lordotic profiles achievable with the implant 10 of the present disclosure. For example, the physician can actuate the anterior actuation assembly 94 to a first expanded configuration and the posterior actuation assembly 96 to a second expanded configuration to provide a difference between the first distance D₁ and the second distance D₂. In particular, the physician can actuate one of the anterior and posterior actuation assemblies 94, 96 to the fully expanded configuration while the other actuation assembly 96, 94 remains near the fully collapsed configuration to provide the implant 10 with a maximum lordotic angle β in the range of about 0 degrees and about 45 degrees. It is to be appreciated that the physician can independently place each of the actuation assemblies 94, 96 in the collapsed configuration, the fully expanded configuration, or any position therebetween to provide the implant 10 with the desired lordotic angle β. It is also to be appreciated that an initial lordotic angle β can be built in to the implant 10. In such embodiments, the inferior and superior bone plates 20, 22 can be configured such that the bone-contacting surfaces 28, 30 thereof are oriented at a lordotic angle β when the implant 10 is in the collapsed configuration.

The tilting can be rendered possible at least because the inferior plate 20 is rotationally interlocked with the first wedge 51, the superior plate 22 is rotationally interlocked with the second wedge 52, the second wedge 52 is rotationally interlocked with the third wedge 53, the third wedge 53 is rotatable about the respective central shaft axis X₁ relative to the fourth wedge 54 (as shown in FIG. 41), and the fourth wedge 54 is rotationally interlocked with the inferior plate 20 (either directly, as in the first phase of expansion, or via rotationally interlocking with the first wedge 51, which is rotationally interlocked with the inferior plate 20). It is to be appreciated that the fourth wedge 54 acts as a hinge of the implant 10 that facilitates lordotic tilting of at least one of the plates 20, 22. By utilizing the drive shaft 98 as the “through pin” of the hinge, the strength of the hinge is increased and the number of parts needed to complete the hinge is reduced. Additionally, the base surfaces 68 of the channels 56, 58, the base surfaces 142, 180, 262 of each wedge assembly 124, 126, and the ramp surfaces 148, 188, 190, 234, 268 of each wedge assembly 124, 126 collaboratively provide the implant 10 with added stability and strength to withstand inner body forces during and after implantation.

It is also to be appreciated that implant 10 provides the physician with enhanced freedom regarding the sequencing of achieving the desired expansion and/or lordosis of the implant 10. In particular, after predetermining the desired amount of expansion and/or lordosis of the implant 10 in the intervertebral space 5, the physician can insert the implant 10 in the collapsed configuration into the intervertebral space 5 along the medial-lateral direction, as shown in FIG. 1. If both expansion and lordosis are desired, the physician can expand the implant 10 uniformly to a partially expanded configuration, and then expand or retract the implant 10 in a non-uniform manner to achieve the desired lordotic angle β of the implant 10. The implant 10 can be expanded or retracted non-uniformly in various ways, including, for example: operating one of the actuation assemblies 94, 96 independently; operating both actuation assemblies 94, 96 simultaneously but at different rates; operating both actuation assemblies 94, 96 simultaneously but in different rotational directions; or any combination of the foregoing. The design of the implant 10, as disclosed herein allows the physician to utilize any of the foregoing modes of expansion, contraction and/or lordosis to achieve the final desired configuration, and to adjust the configuration of the implant 10 as necessary, including during subsequent physical procedures on the patient. The compact nature of the implant 10 in the collapsed configuration allows the implant 10 to fit within the standard lumbar disc space. Additionally, because the implant 10 can be adjusted to achieve up to 30 mm or more of expansion and up to 45 degrees or more of lordosis, the physician can use the implant 10 in many different locations within the spine and for many different purposes.

Referring now to FIG. 42, a second embodiment of the implant 10′ is shown. It is to be appreciated that the second embodiment can be similar to the first embodiment of the implant shown in FIGS. 1 through 41. Accordingly, the same reference numbers used above with reference to the first embodiment can be also used with a “prime” notation in reference to second embodiment. It is also to be appreciated that, unless otherwise set forth below, the components (and features thereof) of the implant 10′ of the second embodiment can be similar to those of the first embodiment.

The inferior and superior plates 20′, 22′ of the second embodiment can define a single vertical aperture 34′ extending through the implant 10′ along the vertical direction V. The anterior and posterior portions 36′, 38′ of the implant 10 can be located on opposite sides of the vertical aperture 34′. The distal portion 40′ of the implant 10′ can be spaced from the vertical aperture 34′ in the distal direction.

Referring now to FIG. 43, the anterior and posterior channels 56′, 58′ of each of the inferior and superior plate bodies 24′, 26′ can include a proximal channel portion 55′ that is contoured to match the outer contour of the nut socket 116′. At a distal end of each proximal channel portion 55′, each plate body 24′, 26′ can define a shoulder 57′. The shoulders 57′ of the inferior plate body 24′ can be configured to abut the external faces 138′ of the first wedges 51′ of the anterior and posterior actuation assemblies 94′, 96′. The shoulders 57′ of the superior plate body 22′ can be configured to abut, or at least be adjacent to, the external faces 178′ of the second wedges 52′ of the actuation assemblies 94′, 96′ when the actuation assemblies 94′, 96′ are in the fully expanded configuration.

Each of the channels 56′, 58′ of the inferior plate body 24′ can define a first pair of cutouts 59′ and a second pair of cutouts 61′ spaced from each other along the longitudinal direction L. In each channel 56′, 58′, the cutouts 59′ of the first pair can be opposed to each other along the transverse direction T, and the cutouts 61′ of the second pair can be opposed to each other along the transverse direction T. While the view of FIG. 43 only shows the anterior cutout 61′ of each pair, it is to be appreciated that the posterior cutout 61′ of each pair can be a mirror image of the associated anterior cutout 61′. The first and second pairs of cutouts 59′, 61′ can each be in communication with the plate guide slots 70′ of the inferior plate body 24′ and can be sized to allow the base protrusions 142′ of the first wedges 51′ to be inserted into the plate guide slots 70′ during assembly of the implant 10′.

Each of the channels 56′, 58′ of the superior plate body 26′ can define a pair of central cutouts 63′ generally centered with respect to the longitudinal direction L. In each channel 56′, 58′, the central cutouts 63′ of each pair can be opposed to each other along the transverse direction T. While the view of FIG. 43 only shows the posterior central cutout 63′ of each pair, it is to be appreciated that the anterior central cutout 63′ of each pair can be a mirror image of the associated posterior central cutout 63′. The central cutouts 63′ can each be in communication with the plate guide slots 70′ of the superior plate body 26′ and can be sized to allow the bottom protrusion 270′ (FIGS. 44 through 46) of the fourth wedges 54′ of each actuation assembly 94′, 96′ to be inserted into the plate guide slots 70′ during assembly of the implant 10′.

With continued reference to FIG. 43, each of the plate guide slots 70′ can define a proximal end 70 a′ and a distal end 70 b′. In the inferior plate body 24′, the proximal ends 70 a′ of the plate guide slots 70′ can optionally be configured to abut the base protrusions of the first wedges 51″ of the proximal wedge assemblies 124′, and the distal ends 70 b′ of the plate guide slots 70′ can optionally be configured to abut the base protrusions of the first wedges 51′ of the distal wedge assemblies 126′. While the base protrusions of the first wedges 51″, 51′ of the present embodiment are not visible in FIG. 43, it is to be appreciated that these base protrusions can be configured similarly to the base protrusions 144, 144′ shown in FIGS. 10 through 15. In the superior plate body 26′, the proximal ends 70 a′ of the plate guide slots 70′ can optionally be configured to abut the base protrusions 184′ of the second wedges 52′ of the proximal wedge assemblies 124′ during operation of the implant, such as when each respective actuation assembly 94′, 96′ is in the fully expanded configuration. Similarly, the distal ends 70 b′ of the plate guide slots 70′ can optionally be configured to abut the base protrusions 184′ of the second wedges 52′ of the distal wedge assemblies 126′ during operation of the implant 10′, such as when each respective actuation assembly 94′, 96′ is in the fully expanded configuration. It is to be appreciated that the proximal and distal ends 70 a′, 70 b′ of the guide slots 70′ of the superior plate 22 can impede motion of the second wedges 52′ in the external longitudinal direction L_(E) during expansion of the implant 10.

At the distal portion 40′ of the inferior plate body 24′, the internal face 44′ can define a single transverse slot 73′ elongated along the transverse direction T. The distal portion 40′ of the superior plate body 26′ can define a single transverse protrusion 83′ protruding beyond the internal contact surface 46′ of the superior plate body 26′. When the implant 10′ is in the collapsed configuration, the transverse protrusion 83′ of the superior plate body 26′ can nest within the transverse slot 73′ of the inferior plate body 24′. The transverse protrusion 83′ can define a pair of opposed recesses 85′ extending into the protrusion 83′ along the transverse direction T. The recesses 85′ can be configured to receive therein portions of the heads 110′ of the drive shafts 98′ of the anterior and posterior actuation assemblies 94′, 96′, at least when the implant 10′ is in the collapsed configuration.

It is to be appreciated that the third and fourth wedges 53′, 54′ of each of the actuation assemblies 94′, 96′ of the second embodiment can be different than their counterparts in the first embodiment. Referring to FIGS. 44 through 46, the third wedge body 216′ can define an upper surface 231′ extending between the internal face 226′ and the fourth ramp 234′ along the longitudinal direction L. The third wedge body 216′ can define a vertical aperture 233′ extending through the fourth ramp 234′ and the guide protrusion 236′, and can also define a pair of arms 235′, 237′ extending from the internal face 226′ to the external face 228′. The vertical aperture 233′ can be in communication with the central bore 230′ of the third wedge 53′. A portion of the threading 232′ of the central bore 230′ can be defined on the inner sides of the arms 235′, 237′. Each of the pair of arms 235′, 237′ can define a lower surface 239′ (FIG. 46) that is canted toward the axis X₂ of the central bore 230′ of the third wedge 53′. The rounded portion 244′ of the third wedge 53′ can extend downward from the lower surfaces 239′ of the arms 235′, 237′, and can have a substantially semicircular profile in a vertical-transverse plane. The rounded portion 244′ of the present embodiment can optionally not be inclined with respect to the longitudinal direction L. The rounded portion 244′ can surround at least a portion of the central bore 230′ of the third wedge body 216′.

The fourth wedge body 246′ can define a front basket 253′ extending from the external face 258′ along the external longitudinal direction L_(E). The front basket 253′ can provide the bottom base surface 262 of the fourth wedge body 246′ with increased length and thus increased stability as the bottom base surface 262 abuts and/or translates along the channel base surface 68. The external face 258′ of the fourth wedge body 246′ can be a first external face thereof, and the front basket 253′ can define a second external face 255′ that is spaced from the first external face 256′ along the external longitudinal direction L_(E). The second external face 255′ can be positioned at the external end 250′ of the fourth wedge body 246′. The bottom surface 262′ of the fourth wedge body 246′ can extend from the internal face 256′ to the sixth ramp 268′ along the longitudinal direction L and can extend along a portion of the basket 253′. The sixth ramp 268′ can extend from the bottom surface 262′ to the second external face 255′ of the fourth wedge body 246′. The guide protrusion 270′ of the fourth wedge body 246′ of the second embodiment can be configured similarly to the guide protrusion 270′ of the first embodiment.

The basket 253′ can define a central recess 257′ extending along the longitudinal direction L. The central recess 257′ can be characterized as an extension of the central bore 264′ of the fourth wedge body 246′ along the basket 253′. The central recess 257′ can separate an upper portion of the basket 253′ into a pair of arms 259′, 261′ that each extend generally along the longitudinal direction L and each have an upper surface 263′ that is canted towards the central bore axis X₃ of the fourth wedge 54′. The basket 253′ can also define a trough 265′ configured to receive the rounded portion 244′ of the third wedge body 216′. The trough 265′ can have a rounded profile that corresponds to the profile of the rounded portion 244′ of the third wedge body 216′ and can allow the rounded portion 244′ of the third wedge body 216′ to rotate within the trough 265 about the central bore axis X₃ of the third wedge body 216′. The central recess 257′ can also define a portion of the threading 266′ of the central bore 264′ of the fourth wedge body 246′. The fourth wedge body 216′ can define a vertical aperture 267′ extending through the basket 253′ at the external end 250′ thereof. The vertical apertures 233′, 267′ of the third and fourth wedge bodies 216′, 246′ can be aligned with one another along the vertical direction V.

As shown in FIGS. 44 and 45, the third wedge body 216′ can be coupled to the fourth wedge body 54′ such that: the rounded portion 244′ of the third wedge body 216′ is received within the trough 265′ of the fourth wedge body 246′; the internal face 226′ of the third wedge body 216′ abuts or is adjacent to the first external face 256′ of the fourth wedge body; and the external face 228′ of the third wedge body 216′ is substantially aligned with the second external face 255′ of the fourth wedge body 246′ along the vertical direction V. When the plates 20′, 22′ are at a neutral (i.e., non-lordotic) configuration, a gap 275′ is defined between the lower surfaces 239′ of the arms 235′, 237′ of the third wedge body 216′ and the upper surfaces 263′ of the arms 259′, 261′ of the fourth wedge body 246′. The gap 275′ and the canted arm surfaces 239′, 263′ can be configured to allow the third wedge body 216′ to rotate relative to the fourth wedge body 246′, as shown in FIG. 45. Additionally, the rounded portion 244′ of the third wedge body 216′ and the trough 265′ of the fourth wedge body 246′ can be cooperatively configured to translationally affix the third and fourth wedges 53′, 54′ together with respect to translation along the drive shaft 98′.

Referring now to FIG. 47, the second embodiment of the implant 10′ is shown with each wedge assembly 124′, 126′ in the fully expanded configuration (with the superior plate 22′ removed for visualization purposes). It is to be appreciated that the actuation assemblies 94′, 96′ and the wedge assemblies 124′, 126′ of the second embodiment can operate as set forth above with respect to those of the first embodiment.

Referring now to FIGS. 48 and 49, the actuation assemblies 94′, 96′ of the implant 10′ can be operated independently so that the superior plate 22′ is tilted relative to the inferior plate 20′ with respect to the transverse direction T so as to provide the implant 10′ with a lordotic profile, as set forth above. As shown in FIG. 48, the inferior and superior bone-contacting surfaces 28′, 30′ can be oriented at a lordotic angle β in the range of about 0 degrees and about 25 degrees. As set forth above, when at least one of the plates 20′, 22′ is tilted lordotically with respect to the other, a first vertical distance D₁ between the inferior and superior bone-contacting surfaces 28′, 30′ that intersects the associated central shaft axis X₁ can be shorter or longer than a second vertical distance D₂ between the bone-contacting surfaces 28′, 30′ that intersects the associated central shaft axis X₁. Additionally, when at least one of the plates 20′, 22′ is tilted lordotically with respect to the other, a vertical distance D₃ between the inferior and superior plates 20′, 22′ at the anterior side 16′ of the implant 10′ can be shorter or longer than a vertical distance D₄ between the plates 20′, 22′ at the posterior side 18′ of the implant 10, as set forth above.

As shown in the example lordotic configuration of FIG. 49, in the anterior actuation assembly 94′, the proximal and distal wedge assemblies 124′, 126′ thereof can be near the collapsed configuration while, in the posterior actuation assembly 96′, the wedge assemblies 124′, 126′ thereof can be expanded near or at the fully expanded configuration, thus causing the lordotic tilting of the superior plate 22′. It is to be appreciated that, while FIG. 49 illustrates the inferior and superior plates 20′, 22′ separated vertically to provide an unobstructed view of the actuation assemblies 94′, 96′, the plates 20′, 22′ are shown at the same lordotic angle β as in FIG. 48.

It is to be appreciated that, while the illustrated embodiments depict the implant 10 having a pair of actuation assemblies 94, 96, in other embodiments (not shown), the implant 10 can have a single actuation assembly 94 to expand the implant 10 along the vertical direction V. In one such embodiment, the plates 20, 22 can be configured to maintain contact with each other in a hinge-like manner at one of the anterior and posterior sides 16, 18 so that operation of the single actuation assembly 94 expands the implant 10 vertically and simultaneously provides lordosis.

Referring now to FIG. 50, a driving tool 300 can be configured to engage the anterior and posterior actuation assemblies 94, 96 of the implant 10. For example, the driving tool 300 can include a handle 302 coupled to a first driver 304 and a second driver 306 that are spaced from each other along the transverse direction T. The first driver 304 can carry a first bit 308 configured to engage the drive coupling of the anterior actuation assembly 94 while the second driver 306 can carry a second bit 310 configured to engage the drive coupling of the posterior actuation assembly 96. For example, in the illustrated embodiments, the first and second bits 308, 310 can each define a hex profile configured to engage a corresponding hex profile of the socket aperture 118 of the corresponding actuation assembly 94, 96.

The driving tool 300 can include a one or more selector switches that allows the physician to select between various modes of operation of the tool 300. For example, a first selector switch 312 can toggle between a first drive mode A, a second drive mode B, and a third drive mode C. In the first drive mode A, the tool 300 can be set to operate only the first driver 304. In the second drive mode B, the tool 300 can be set to operate the first and second drivers 304, 306 simultaneously. In the third mode C, the tool 300 can be set to operate only the second driver 306.

A second selector switch 314 can be in communication with the first driver 304. For example, the second selector switch 314 can toggle between a first position E, wherein the tool 300 is set to rotate the first driver 304 in the clockwise direction, and a second position F, wherein the tool 300 is set to rotate the first driver 304 in the counterclockwise direction. Similarly, a third selector switch 316 can be in communication with the second driver 306. For example, the third selector switch 316 can toggle between a first position G, wherein the tool 300 is set to rotate the second driver 306 in the clockwise direction, and a second position H, wherein the tool 300 is set to rotate the second driver 306 in the counterclockwise direction.

A fourth selector switch 318 can allow the physician to select a torque and/or speed setting of the first driver 304. A fifth selector switch 320 can allow the physician to select a torque and/or speed setting of the second driver 306. Accordingly, the first, second, third, fourth, and fifth selector switches 312, 314, 316, 318, 320 allow the physician to use the tool 300 to operate the anterior and posterior actuation assemblies 94, 96 uniformly or independently as desired. Additionally, the selector switches can also allow the physician to tailor the rotational direction, speed and/or torque of each of the actuation assemblies 94, 96 independently.

Although the disclosure has been described in detail, it should be understood that various changes, substitutions, and alterations can be made herein without departing from the spirit and scope of the invention as defined by the appended claims. Additionally, any of the embodiments disclosed herein can incorporate features disclosed with respect to any of the other embodiments disclosed herein. Moreover, the scope of the present disclosure is not intended to be limited to the particular embodiments described in the specification. As one of ordinary skill in the art will readily appreciate from that processes, machines, manufacture, composition of matter, means, methods, or steps, presently existing or later to be developed that perform substantially the same function or achieve substantially the same result as the corresponding embodiments described herein may be utilized according to the present disclosure. 

1. An intervertebral implant configured to iterate between a collapsed configuration and an expanded configuration, the implant comprising: a first plate and a second plate spaced from one another along a first direction, the first plate defining a first bone-contacting surface, the second plate defining a second bone-contacting surface facing away from the first bone-contacting surface along the first direction; an expansion assembly disposed between the first and second plates with respect to the first direction, the expansion assembly including: a first support wedge supporting the first plate, the first support wedge defining a first ramp; a second support wedge supporting the second plate, the second support wedge defining a second ramp and a third ramp; and an expansion wedge defining a fourth ramp, wherein each of the first, second, third, and fourth ramps is inclined with respect to a second direction that is substantially perpendicular to the first direction, and at least one of the first and second support wedges is slidable along the respective supported first or second plate; and an actuator configured to apply a drive force to the expansion wedge so as to cause 1) the fourth ramp to ride along the third ramp so as to increase a distance between the first and second bone-contacting surfaces along the first direction, and 2) the second ramp to ride along the first ramp, thereby further increasing the distance, thereby iterating the implant from the collapsed configuration to the expanded configuration.
 2. The implant of claim 1, wherein the distance increases at least by a factor of 2.0 between the collapsed and expanded configurations.
 3. The implant of claim 1, wherein each of the first, second, third, and fourth ramps is inclined at an incline angle in the range of about 10 degrees and about 60 degrees.
 4. The implant of claim 3, wherein the expansion wedge defines an additional ramp configured to ride along the first ramp responsive to the drive force, and the additional ramp is inclined at an angle in the range of about 20 degrees and about 50 degrees.
 5. The implant of claim 1, wherein: when the implant is in the collapsed configuration, an entirety of the first support wedge is spaced from an entirety of the expansion wedge with respect to the second direction, and at least a portion of the second support wedge is disposed between the first support wedge and the expansion wedge with respect to the second direction; and when the implant is in the expanded configuration, the first support wedge underlies an entirety of the expansion wedge with respect to the first direction, and an entirety of the second support wedge is spaced from an entirety of the first support wedge with respect to the first direction.
 6. The implant of claim 5, wherein the first plate defines a first channel elongate along the second direction, the second plate defines a second channel elongate along the second direction, the first and second channels are open toward one another and overly one another so as to define a compartment, and each of the wedges is housed within the compartment when the implant is in the collapsed configuration.
 7. The implant of claim 6, wherein: the first channel defines a first base surface extending along the second direction and a third direction that is perpendicular to the first and second directions; the second channel defines a second base surface extending along the second and third directions, and the first and second base surfaces face one another; the second support wedge defines a wedge base surface that is configured to slide along the second base surface during expansion of the implant between the collapsed configuration and the expanded configuration, and the expansion wedge defines another wedge base surface that is configured to ride along the first base surface during expansion of the implant.
 8. The implant of claim 7, wherein the expansion wedge further defines an additional ramp that is inclined with respect to the second direction, and the implant is configured such that, during a first phase of expansion of the implant: the additional ramp is remote from the first ramp with respect to the second direction while the second ramp rides along the first ramp and; the fourth ramp rides along the third ramp; and the another wedge base surface rides along the first base surface.
 9. The implant of claim 8, wherein the implant is configured such that, during a second phase of expansion of the implant, 1) the additional ramp rides along the first ramp, and 2) the second ramp is remote from the first ramp.
 10. The implant of claim 1, wherein the actuator is rotatable about an axis oriented along the second direction, and the actuator drives the expansion wedge to translate along the second direction as the fourth ramp rides along the third ramp.
 11. The implant of claim 1, wherein the actuator is threadedly coupled to the expansion wedge, such that rotation of the actuator about the axis causes the expansion wedge to threadedly translate along the actuator.
 12. The implant of claim 1, wherein: the expansion assembly is a first expansion assembly; and the implant further comprises a second expansion assembly disposed between the first and second plates with respect to the first direction, the second expansion assembly spaced from the first expansion assembly along the second direction, the second expansion assembly including: a third support wedge supporting the first plate, the third support wedge defining a fifth ramp; a fourth support wedge supporting the second plate, the second support wedge defining a sixth ramp and a seventh ramp; and a second expansion wedge defining an eighth ramp, wherein each of the fifth, sixth, seventh, and eighth ramps is inclined with respect to the second direction, and at least one of the third and fourth support wedges is slidable along the respective supported first or second plate, and the actuator is configured to apply a second drive force to the second expansion wedge so as to cause 1) the eighth ramp to ride along the seventh ramp as the fourth ramp rides along the third ramp so as to collectively increase the distance between the first and second plates along the first direction, and 2) the sixth ramp to ride along the fifth ramp as the second ramp rides along the first ramp so as to collectively further increasing the distance between the first and second plates along the first direction, thereby iterating the implant from the collapsed configuration to the expanded configuration.
 13. The implant of claim 1, wherein the expanded configuration is a first expanded configuration, expansion assembly is a first expansion assembly, the distance is a first distance, and the implant further comprises: a first side and a second side spaced from the first side along a third direction that is substantially perpendicular to the first and second directions, wherein the first distance is measurable at the first side of the implant; a second expansion assembly disposed between the first and second plates with respect to the first direction, the second expansion assembly spaced from the first expansion assembly along the third direction, the second expansion assembly including: a third support wedge supporting the first plate, the third support wedge defining a fifth ramp; a fourth support wedge supporting the second plate, the second support wedge defining a sixth ramp and a seventh ramp; and a second expansion wedge defining an eighth ramp, wherein each of the fifth, sixth, seventh, and eighth ramps is inclined with respect to the second direction, and at least one of the third and fourth support wedges is slidable along the respective plate supported by the one of the third and fourth support wedges; and a second actuator configured to apply a second drive force to the second expansion wedge so as to cause 1) the eighth ramp to ride along the seventh ramp so as to increase a second distance between the first and second plates along the first direction, wherein the second distance is measurable at the second side, and 2) the sixth ramp to ride along the fifth ramp so as to further increasing the second distance between the first and second plates along the first direction, thereby iterating the implant from the collapsed configuration to the second expanded configuration, wherein, in the second expanded configuration, the second distance is different than the first distance such that one of the first and second plates is tilted with respect to the other of the first and second plate.
 14. An implant for lateral insertion into an intervertebral space, the implant comprising: an expansion mechanism disposed between a first endplate and a second endplate with respect to a vertical direction, the first endplate defining a first-bone contacting surface, the second endplate defining a second bone-contacting surface facing away from the first bone-contacting surface along the vertical direction, the expansion mechanism comprising: an anterior actuation assembly arranged along a first axis; and a posterior actuation assembly arranged along a second axis, the first and second axes each oriented along a longitudinal direction that is substantially perpendicular to the vertical direction, the first and second axes spaced from one another along a transverse direction that is substantially perpendicular to the vertical and longitudinal directions, wherein a first distance between the first and second bone-contacting surfaces along the vertical direction intersects the first axis, and a second distance between the first and second bone-contacting surfaces along the vertical direction intersects the second axis, the anterior and posterior actuation assemblies each comprising: a first support wedge that supports the first endplate; a second support wedge that supports the second endplate, the second support wedge slidable with respect to the first support wedge; and an expansion wedge slidable with respect to the second support wedge; and a drive shaft coupled to the expansion wedge, the drive shaft rotatable about the respective first or second axis so as to cause 1) the expansion wedge to ride along the second support wedge, and 2) the second support wedge to ride along the first support wedge, thereby varying the respective first or second distance; wherein the drive shafts of the anterior and posterior actuation assemblies are rotatable independently of each other so as to provide a difference between the first and second distances.
 15. The implant of claim 14, wherein each expansion wedge comprises a first member and a second member, the first member is rotatable with respect to the second member about the respective first or second axis, and the first member is configured to ride along the respective second support wedge responsive to rotation of the respective drive shaft, and the second member is configured to ride along the respective first support wedge responsive to rotation of the respective drive shaft.
 16. The implant of claim 15, wherein: each endplate defines an anterior guide feature and a posterior guide feature, each of the anterior and posterior guide features extending along the longitudinal direction, each second support wedge includes a guide element configured to ride along the respective anterior or posterior guide feature of the second endplate; and the second member of each expansion wedge includes a guide element configured to ride along the respective anterior or posterior guide feature of the first endplate.
 17. The implant of claim 16, wherein each second support wedge further includes a guide feature, and the first member of each expansion wedge defines a guide element configured to ride within the guide feature of the respective second support wedge.
 18. The implant of claim 17, wherein each first support wedge defines a guide feature, and the guide element of the respective second member is further configured to ride along the guide feature of the respective first support wedge.
 19. The implant of claim 18, wherein each of the guide features is a guide slot, and each of the guide elements is a guide protrusion configured to extend within and ride along the associated guide slot.
 20. The implant of claim 19, wherein: the guide slots of the second endplate and the respective guide protrusions of the second support wedges are cooperatively shaped so as to rotationally interlock the second endplate to each of the second support wedges with respect to rotation about the respective first or second axis; and the guide slots of the second support wedges and the respective guide protrusions of the first members are cooperatively shaped so as to rotationally interlock the second support wedges to the respective first members with respect to rotation about the respective first or second axis.
 21. The implant of claim 20, wherein, each first support wedge is fixed to the first endplate with respect to rotation about the respective first or second axis; the guide protrusion of each second member and the respective guide slot of the first endplate are cooperatively shaped so as to rotationally interlock the first endplate to the associated second member when the guide protrusion of the associated second member extends within the respective guide slot; and the guide protrusion of each second member and the guide slot of the respective first support wedge are cooperatively shaped so as to rotationally interlock each first support wedge to the associated first member when the guide protrusion of the associated first member extends within the guide slot of the associated first support wedge. 